Expression of β-Adrenoceptor Subtypes in Urothelium, Interstitial Cells and Detrusor of the Human Urinary Bladder

OBJECTIVE

We examined whether interstitial cells (ICs) of the human urinary bladder expressed β-adrenoceptor (AR) subtypes, and semiquantitatively compared the staining intensity among urothelium, ICs and detrusor muscles.

METHODS

Paraffin sections of the human urinary bladder were obtained from histologically normal areas of formalin-fixed specimens removed for bladder carcinoma. Double-labeling immunohistochemical methods using antibodies against each β-AR subtype and vimentin were performed to identify ICs of the human urinary bladder. The staining intensity of β-ARs was semiquantitatively compared among urothelium, ICs and detrusor muscles. Further, gender-related difference or age-related correlation in the staining intensity of β-ARs was compared in the same cell types.

RESULTS

The expression of β1 -, β2 -, and β3 -AR was observed in vimentin-positive ICs localized in suburothelium, between detrusor muscle bundles, and within these bundles of the human urinary bladder. The rank order of the staining intensity was urothelium > ICs = detrusor muscles in β1 -AR, urothelium > ICs > detrusor muscles in β2 -AR, whereas its order was ICs = detrusor muscles > urothelium in β3 -AR. Except for urothelial β1 -AR, there was no gender-related difference in the signal intensity of β-ARs in the urothelium, ICs or detrusor muscles. Age negatively correlated with the signal intensity of all β-AR subtypes.

CONCLUSION

β-ARs were expressed in vimentin-positive ICs of the human urinary bladder. As for β2 - and β3 -AR, there was no gender-related difference or age-related correlation in urothelium, ICs and detrusor muscles. In the human urinary bladder, β-ARs expressed in ICs may play a role in bladder physiology.

Successful treatment for adrenocorticotropic hormone-independent macronodular adrenal hyperplasia with laparoscopic adrenalectomy: a case series

Introduction

Adrenocorticotropic hormone-independent macronodular adrenal hyperplasia, characterized by bilateral macronodular adrenal hypertrophy and autonomous cortisol production, is a rare cause of Cushing’s syndrome. Bilateral adrenalectomy is considered the standard treatment for adrenocorticotropic hormone-independent macronodular adrenal hyperplasia but obliges the patient to receive lifetime steroid replacement therapy subsequently, and may increase the patient’s risk of adrenal insufficiency. These circumstances require surgeons to carefully consider operative strategies on an individual basis.

Case presentation

We performed successful laparoscopic adrenalectomy on four patients with adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. Computed tomography scans showed bilateral adrenal enlargement in all patients. Case 1: a 56-year-old Japanese woman presented with obvious Cushing’s symptoms during treatment for diabetes mellitus and hypertension. Case 2: a 37-year-old Japanese man also presented with Cushing’s symptoms during treatment for diabetes mellitus and hypertension. These patients were diagnosed as Cushing’s syndrome caused by adrenocorticotropic hormone-independent macronodular adrenal hyperplasia based on endocrinologic testing, and underwent bilateral laparoscopic adrenalectomy. Case 3: an 80-year-old Japanese woman was hospitalized due to unusual weight gain and heightened general fatigue, and was diagnosed as Cushing’s syndrome caused by adrenocorticotropic hormone-independent macronodular adrenal hyperplasia. She underwent unilateral laparoscopic adrenalectomy due to high operative risk. Case 4: a 66-year-old Japanese man was discovered to have bilateral adrenal tumors on medical examination. He did not have Cushing’s symptoms and was diagnosed as subclinical Cushing’s syndrome due to suppressed adrenocorticotropic hormone serum levels and loss of cortisol circadian rhythm without abnormal levels of serum cortisol. He underwent unilateral laparoscopic adrenalectomy. During follow-up, serum cortisol levels were within the normal range in all cases, and serum adrenocorticotropic hormone levels were not suppressed. Further, cases with Cushing’s syndrome experienced clinical improvement.

Conclusions

We were able to effectively treat adrenocorticotropic hormone-independent macronodular adrenal hyperplasia in patients with obvious Cushing’s symptoms by laparoscopic bilateral adrenalectomy, which promptly improved symptoms. Further, unilateral adrenalectomy was effective for treating an older patient at high operative risk and a patient with subclinical Cushing’s syndrome.

[A case of ductal adenocarcinoma of the prostate treated with endocrine therapy and radiation therapy]

We report a case of ductal adenocarcinoma of the prostate. A 81-year-old man presented with a complaint of microhematuria. Serum prostate specific antigen (PSA) was 18. 44 ng/ml. A cystourethroscopic examination revealed a papillary tumor near the verumontanum. Transurethral resection of the tumor and transrectal prostatic needle biopsy was carried out. The pathological diagnosis was ductal adenocarcinoma and acinar adenocarcinoma of the prostate. The tumor responded to endocrine therapy and radiation therapy. At the follow up at 18 months, the PSA level was in the undetectable range (＜0.01 ng/ml), and no reccurence of the tumor was seen. Pathogenesis and management of this rare condition is discussed.

Seasonal changes in symptom score and uroflowmetry in patients with lower urinary tract symptoms

OBJECTIVE

To determine whether subjective or objective seasonal changes occur in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).

MATERIAL AND METHODS

A total of 31 patients with LUTS were observed for >5 years. Their International Prostate Symptom Score (IPSS), quality of life (QOL) score, maximum flow rate (Qmax), voided volume (VV) a nd post-void residual (PVR) we re measured every month.

RESULTS

Total IPSS, QOL, VV or PVR did not show any seasonal changes between the three seasons: summer (hot season: June to September); winter (cold season: December to March); and spring and fall (comfortable season: April, May, October and November). Furthermore, when the IPSS was examined by dividing it into storage symptoms (frequency, urgency and nocturia) and voiding symptoms (incomplete emptying, intermittency, weak stream and straining), no significant seasonal changes were detected. Only Qmax showed a significant seasonal change, being higher in both the cold season (median 10.4 ml/s) and the comfortable season (median 10.1 ml/s) than in the hot season (median 9.4 ml/s).

CONCLUSIONS

It has generally been thought that LUTS worsen in winter. Our results indicate that the IPSS and the QOL score remain nearly constant if they are determined regularly over an extended period of time. Qmax may however be influenced by seasonal changes in temperature.

Effects of a novel beta(3)-adrenoceptor agonist, AJ-9677, on relaxation of the detrusor muscle: an in vitro study

OBJECTIVES

To examine the relaxant effects of AJ-9677, a novel beta(3)-adrenoceptor agonist, on the isolated rat, monkey and human detrusor muscle.

METHODS

The isolated detrusor strips of rats, monkeys and humans were mounted in organ baths containing Krebs solution. By the cumulative addition of beta-adrenoceptor agonists (isoproterenol, AJ-9677, CL 316,243 and salbutamol in rats; isoproterenol, AJ-9677 and CL 316,243 in monkeys and humans), concentration-relaxation curves were obtained. The maximal relaxation responses and pEC(50) values were calculated. In rats, concentration-relaxation curves to isoproterenol and AJ-9677 were obtained in the presence and absence of propranolol or SR 59230A.

RESULTS

Isoproterenol, AJ-9677, CL 316,243 and salbutamol induced concentration-dependent relaxation in rats. The rank order of their relaxing potency in the rat detrusor muscle was AJ-9677 > isoproterenol > CL 316,243 > salbutamol. Isoproterenol and AJ-9677 also produced a concentration-dependent relaxation with high potency in monkeys and humans, whilst CL 316,243 had low relaxing potency. According to the antagonist studies in rats, propranolol and SR 59230A caused a rightward shift of the concentration-relaxation curves to isoproterenol or AJ-9677, respectively.

CONCLUSIONS

AJ-9677 has a high relaxant potency on the rat, monkey and human detrusor smooth muscle, and it may have the potential to treat overactive bladder.

Expression and functional role of beta-adrenoceptors in the human urinary bladder urothelium

We investigated the presence of beta-adrenoceptor subtypes in human urinary bladder urothelium and examined whether beta-adrenoceptors in the urothelium modulate the relaxation responses of isolated human detrusor strips to a beta-adrenoceptor agonist. Expression of beta1-, beta2-, and beta3-adrenoceptor mRNA in urothelium and detrusor smooth muscle was determined by reverse transcription-polymerase chain reaction, and the distribution of beta1-, beta2-, and beta3-adrenoceptors in human urinary bladder urothelium were examined by immunohistochemistry. Paired human longitudinal detrusor strips with and without an intact urothelium were suspended in organ baths to construct concentration-response curves to isoproterenol. The possible involvement of urothelium-derived nitric oxide (NO) in this response was examined in additional experiments with urothelium-intact strips in the presence of NG-nitro-L-arginine methylester (L-NAME). Results confirmed the expression of beta1-, beta2-, and beta3-adrenoceptors in the human urinary bladder urothelium. Further, the presence of the urothelium caused a parallel rightward shift of the concentration-response curve to isoproterenol with a significant reduction in potency (pEC50). L-NAME failed to exert any significant effect on the relaxation response to isoproterenol in the urothelium-intact strips. These results confirm the presence of beta1-, beta2-, and beta3-adrenoceptors in human urinary bladder urothelium. Further, they suggest that urothelial beta-adrenoceptors induce the release of a urothelium-derived factor which inhibits the beta-adrenoceptor agonist-induced relaxation of the human detrusor smooth muscle and that this inhibitory mechanism might not involve NO.

[Primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma: a case report]

We present a case of primary ureteral carcinoma composed of both transitional cell carcinoma and mucinous carcinoma. A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen. Percutaneous nephrostomy was performed for hydronephrosis and pyonephrosis. The urinary cytology revealed class V, transitional cell carcinoma. Re-abdominal CT showed further enlargement of tumor diameter, but the primary site of the tumor was not identified. Her general condition worsened, and she died 42 days after her initial complaint. Pathologic examinations upon autopsy revealed both mucinous carcinoma and transitional cell carcinoma in the right ureter. Pathogenesis and management of this rare condition are discussed.

Human Muscarinic Receptor Binding Characteristics of Antimuscarinic Agents to Treat Overactive Bladder

PURPOSE

We characterized the binding affinities of several antimuscarinic agents in human muscarinic receptors.

MATERIALS AND METHODS

Competitive inhibitory effects of antimuscarinic agents on specific NMS [H] (PerkinElmer Life Sciences, Boston, Massachusetts) binding were examined in human tissue homogenates and in CHO-K1 cell membranes expressing human muscarinic receptor subtypes.

RESULTS

Oxybutynin, propiverine, tolterodine, the respective metabolites DEOB, DPr-P-4(N-->O) and 5-HM, and darifenacin inhibited in concentration dependent fashion specific [(3)H]NMS binding in homogenates of the human bladder and parotid gland as well as in membranes of CHO-K1 cell lines expressing human muscarinic M(1) to M(5) receptor subtypes. Based on inhibition constant values the inhibitory effects of tolterodine, 5-HM and DPr-P-4(N-->O) were 1.4 to 1.7 times greater in the bladder than in the parotid gland, whereas the inhibitory effects of oxybutynin, DEOB, propiverine and darifenacin were 2 to 10 times greater in the parotid gland. Consequently tolterodine, 5-HM and DPr-P-4(N-->O) compared with oxybutynin, DEOB, propiverine and darifenacin were found to show 3 to 4 times greater affinity to muscarinic receptors in the human bladder than in the parotid gland. Tolterodine and 5-HM were 2-fold more potent for inhibiting specific [(3)H]NMS binding at cell membranes expressing the M(2) vs the M(3) subtype. Conversely oxybutynin, DEOB, propiverine, DPr-P-4(N-->O) and darifenacin showed 2 to 22 times higher affinity to the M(3) than to the M(2) subtype.

CONCLUSIONS

Compared with oxybutynin, tolterodine, 5-HM and DPr-P-4(N-->O) may bind more selectively to muscarinic receptors in the human bladder than in the parotid gland.

Oral clonidine advances spermatogenesis in oligozoospermic patients with spermatogenetic maturation arrest

BACKGROUND

Growth hormone (GH) plays an important role in the pubertal development of males and females, and influences the male reproductive function after puberty. The purpose of this study was to investigate the cause of GH deficiency in infertile men with spermatogenetic maturation arrest using the clonidine loading test (GH stimulation test). Based on the results of the loading test, we tried to con fi rm whether clonidine might be usable as a male infertility remedy.

METHODS

We studied 75 infertile men (55 oligozoospermic and 20 azoospermic men) and 25 normal fertile volunteers. We used the oral clonidine (0.15 mg/m2) loading test to evaluate the GH secretory reserve. Histological diagnoses were performed using testicular biopsy and testicular sperm extraction specimens.

RESULTS

The most important finding was that the clonidine loading test caused a good response in 41 out of 55 (74.6%) patients with oligozoospermia. We treated these 41 good-response patients with oral clonidine, and the sperm count improved in 34 (82.9%) cases, increasing to 12-79 million/mL. Spontaneous pregnancy was subsequently achieved by 10 (24.4%) couples.

CONCLUSIONS

These findings also suggest that GH is necessary for spermatogenesis, at least for the process of spermatozoa maturation. Oral clonidine therapy improved the sperm count in patients who showed an excessive response to the clonidine loading test.

Mechanisms responsible for increase in circulating inhibin levels at the time of ovulation in mares

In female mammals, inhibin is secreted by the granulosa cells and selectively inhibits secretion of FSH. Although circulating immunoreactive (ir)-inhibin levels decrease after ovulation as a result of the disappearance of its main source, they abruptly increase at the time of ovulation in mares. To investigate the mechanisms responsible for this increase, 50 ml of equine follicular fluid (eFF) was administered into the abdominal cavity of mares during the luteal phase (eFF, n = 4). One hour after treatment, plasma levels of ir-inhibin and inhibin pro-alphaC (but not estradiol-17beta) were significantly higher in eFF-treated mares than in control mares (n = 4). The hormone profiles in eFF-treated mares were similar to those in mares with the spontaneous or hCG induced ovulations. The present study demonstrates that the release of follicular fluid into the abdominal cavity when the follicle ruptures is responsible for the ovulatory inhibin surge in the mare. These findings also suggest that circulating inhibin pro-alphaC may be useful for determining the time of ovulation in the mare.

[Sling suspension of incontinent urinary reservoir]

We report a case and surgical technique of successful sling suspension of insufficient efferent limb of continent urinary reservoir, which has occurred urinary incontinence. A 64-year-old male, who received radical cystectomy with continent urinary reservoir, had been suffered urinary incontinence from the reservoir about one year after surgery. Various procedures, such as the repair of the efferent limb of the reservoir, addition of the ileal patch, instillation of scopolamine, oxybutynin into the reservoir and an injection of GAX collagen in the efferent limb, were not effective for his urinary incontinence. Finally, anti-incontinence procedure of sling at an efferent limb using abdominal rectus muscle fascia was employed and obtained a continence for 2 years after operation. The principle of this surgery is same with that of sling suspension for female stress incontinence. It is advisable for the incontinent urinary reservoir when it has an enough length of efferent limb.

Simultaneous bilateral laparoscopic adrenalectomy in ACTH-independent macronodular adrenal hyperplasia

Laparoscopic surgery for urological conditions has now become popular worldwide. The case is reported of a 56-year-old woman who underwent simultaneous bilateral laparoscopic adrenalectomy for adrenocorticotropic hormone-independent macronodular adrenocortical hyperplasia (AIMAH), followed by autotransplantation of resected adrenal gland fragments. Simultaneous laparoscopic adrenalectomies seem feasible for a patient with AIMAH because of its minimally invasive nature. However, autotransplantation of adrenal fragments failed in this patient with AIMAH.

Voiding dysfunction in a patient with adolescent adrenoleukodystrophy

The details are reported of bladder dysfunction in a Japanese boy with adrenoleukodystrophy. He developed gait disturbance at the age of 15 years. Spastic paraparesis progressed from the legs to the hands and brain magnetic resonance imaging showed characteristic degenerative change. Detrusor hyperreflexia was found by a urodynamic study and detrusor-sphincter dyssynergia was also suspected.

Effect of age on the responses of rat bladder detrusor strips to adenosine triphosphate

OBJECTIVE

To assess age-related changes in bladder function using the contractile responses to ATP of detrusor strips from rats of various ages. Materials and methods Urinary bladders were obtained from male Wistar rats aged 9 weeks (young), 24 weeks (adult) and 24 months (aged). Contractions of urinary bladder muscle strips to ATP were measured isometrically. The size of the initial phasic response and the secondary contractile response that developed after washing out ATP (postwashout contraction) were measured. The magnitudes of the ATP-induced phasic and postwashout contraction were compared among the age groups. During the contractions, prostanoid concentrations in the organ-bath medium were measured using an enzyme immunoassay.

RESULTS

The ATP-induced postwashout contraction did not occur after stimulation with KCl or acetylcholine, but was induced by alpha,beta-methylene ATP. Both the phasic and postwashout contractions were concentration-dependent. Although the phasic contraction did not change progressively with age, the magnitude and duration of the postwashout contraction increased substantially with age. Nicardipine (a calcium antagonist) slightly inhibited both contractions. Suramin (a nonselective P2-receptor antagonist) did not significantly inhibit the phasic contraction, but reduced the postwashout contraction. PPADS (a selective P2X receptor antagonist) did not inhibit either contraction. Indomethacin (a prostaglandin synthesis inhibitor) had no effect on the phasic contraction but almost completely blocked the postwashout contraction when added before ATP stimulation, but was less effective when added after ATP. The prostaglandin E2 concentration in the organ bath increased during the postwashout contraction.

CONCLUSIONS

These findings suggest that the ATP-induced postwashout contraction is not directly mediated by P2x purinoceptors, but results from the synthesis of prostaglandins, especially E2, which is a sensory autacoid. The age-linked increase in postwashout contraction may be involved in the changes in sensory and voiding mechanisms seen in the aged urinary bladder.

A selective increase in circulating inhibin and inhibin pro-alphaC at the time of ovulation in the mare

The relationship between a selective increase in circulating immunoreactive (ir)-inhibin and the time of ovulation was investigated in mares. Concentrations of plasma ir-inhibin were measured every 4 h during the periovulatory period. Inhibin pro-alphaC, a precursor protein of the inhibin alpha-subunit, was also measured. The changes in ir-inhibin and inhibin pro-alphaC in circulation were parallel. Concentrations of both ir-inhibin and inhibin pro-alphaC in the plasma increased at the same time when ovulatory follicles ruptured, and the peak levels of circulating ir-inhibin and inhibin pro-alphaC were maintained for 4-8 h. There was no selective increase in plasma concentrations of estradiol-17beta during the process of ovulation. These results suggest that the selective increase in ir-inhibin and inhibin pro-alphaC was caused by the absorption of follicular fluid after the rupture of ovulatory follicles. These results also suggest that the measuring of plasma concentrations of ir-inhibin or inhibin pro-alphaC in mares might be a useful method for detecting the time of ovulation.

[A case of primary malignant lymphoma of the bladder]

A case of primary malignant lymphoma of the bladder is reported. A 61-year-old female visited our outpatient clinic with the chief complaints of asymptomatic grosshematuria and was recognized as having a bladder tumor by abdominal ultrasonography. On cystoscopic examination, the tumor was non-papillary and dome-like in shape. Computed tomography revealed that the bladder tumor was invading into the bladder wall. The histopathological study of endoscopic biopsy specimen revealed malignant lymphoma. After further examinations, it was diagnosed as primary malignant lymphoma of bladder, stage IE (Ann Arbor classification). Four courses of CHOP regimen (cyclophosphamide, vincristine, doxorubicin, predonisolone) was performed and no lymphoma cell was found by re-biopsy at the primary site. No local or distant recurrence was found during the 15 months' follow up.

Recycling of urea associated with the host plant urease in the silkworm larvae, Bombyx mori

Urea concentration and urease activity in the midgut content were compared between larvae of the silkworm, Bombyx mori fed an artificial diet and those fed fresh mulberry leaves. A considerable amount of urea was found in the midgut content of the both larvae, however it was significantly lower in the larvae fed fresh mulberry leaves than in the larvae fed the artificial diet; average urea concentrations in the midgut content of the larvae fed fresh mulberry leaves and the artificial diet were 2.9 and 4.6 &mgr;mol/g, respectively. Urea in the midgut content seems to be secreted from the insect itself since the amount of urea in both diets were negligibly small. Urease activity was detected only in the midgut content of the larvae fed fresh mulberry leaves but not in other tissues of the larvae. On the other hand, no urease activity was detected in the midgut content of the larvae fed the artificial diet. Subsequently, to elucidate the role of mulberry leaf urease in the midgut lumen, larvae that had been reared on the artificial diet were switched to fresh mulberry leaves. The diet switch caused a rapid decrease in urea concentration in the midgut content and an increase in ammonia concentration in the midgut content, suggesting that secreted urea could be hydrolyzed to ammonia by mulberry leaf urease in the midgut lumen. Furthermore, to investigate the physiological significance of mulberry leaf urease on urea metabolism of the silkworm, (15)N-urea was injected into the hemocoel, and after 12 h the larvae were dissected for (15)N analysis. A considerable amount of (15)N was found to be incorporated into the silk-protein of the larvae fed fresh mulberry leaves, but there was little incorporation of (15)N into the silk-protein of the larvae fed the artificial diet. These data indicate that urea is converted into ammonia by the action of mulberry leaf urease in the midgut lumen and used as a nitrogen source in larvae fed mulberry leaves.

Purification and characterization of NADH-dependent glutamate synthase from the silkworm fat body (Bombyx mori)

NADH-dependent glutamate synthase (Nadh-Gogat; EC 1.41.14) was purified 766-fold from the fat body of 5th instar larvae of the silkworm with a final specific activity of 13.8 units/mg protein by a produce including ammonium sulfate fraction, Q-Sepharose HP ion exchange column chromatography, Blue Sepharose FF affinity column chromatography and Superdex 200 HR gel filtration. The purified enzyme yielded a single band corresponding to a molecular mass of 195kDa by SDS-polyacrylamide gel electrophoresis. Molecular mass of the native enzyme was estimated to be 190 kDa by Superdex 200HR gel filtration, suggesting that the enzyme is composed of a monomeric polypeptide. The enzyme showed an absorption spectrum with maximum values at 272, 375, and 435 nm, suggesting the presence of a flavin prosthetic group in the enzyme. The N-terminal amino acid sequence showed a high similarity to those of other GOGATs from plants, yeast and bacteria, but no similarity to other known proteins was detected. The enzyme exhibited a strong specificity to the electron donor and substrates; NADH as electron donor, 2-oxoglutarate as amino acceptor and glutamine as amino donor were essential for the catalytic activity. The optimum pH was around 7.5, at which Km values for 2-oxoglutarate, glutamine and NADH were 17, 220 and 5.7 micro M, respectively. Azaserine, 6-diazo-5-oxonorleucine and p-chloromercuribenzoic acid were strong inhibitors of the activity. These result show that NADH-GOGAT in the silkworm fat body strongly resembles other eukaryotic NADH-GOGATs, suggesting that it plays a significant role in ammonia assimilation in the same manner as the other enzymes.

The pathway of ammonia assimilation in the silkworm, Bombyx mori

Ammonia can easily be assimilated into amino acids and used for silk-protein synthesis in the silkworm, Bombyx mori. To determine the metabolic pathway of ammonia assimilation, silkworm larvae were injected with methionine sulfoximine (MS), a specific inhibitor of glutamine synthetase (GS). Activity of GS in the fat body 2h after treatment with 400&mgr;g MS decreased to less than 10% of the control activity, whereas MS had no effect on the activity of glutamate dehydrogenase (GDH), another enzyme which could possibly be responsible for ammonia assimilation. Glutamine concentration in the hemolymph rapidly decreased after MS treatment, while the ammonia level in the hemolymph sharply increased. Glutamine concentration in the hemolymph 4h after injection decreased with increasing doses of MS, whereas ammonia concentration increased in proportion to the MS dose. MS strongly blocked the incorporation of (15)N label into silk-protein in larvae injected with (15)N ammonia acetate, while it slightly inhibited the incorporation of (15)N-amide glutamine into silk-protein. These results suggest that ammonia is mainly assimilated into glutamine via the action of GS and then converted into other amino acids for silk-protein synthesis and that GDH does not play a major role in ammonia assimilation in B. mori.

[Laparoscopic adrenalectomy for Cushing's syndrome: a study of comparisons between laparoscopic and open adrenalectomy, and laparoscopic adrenalectomy for differing adrenal tumors]

In order to evaluate the utility of laparoscopic adrenalectomy for Cushing's syndrome, the results of 6 laparoscopic adrenalectomies for Cushing's syndrome were compared with those of 34 other laparoscopic adrenalectomies, consisting of 7 pre-Cushing's syndromes, 13 primary aldosteronisms, and 14 non-functioning adrenal tumors. The results were also compared with 5 open adrenalectomies for Cushing's syndrome. The results of the laparoscopic adrenalectomies for Cushing's syndrome were as follows: the mean operating time was 216 +/- 46 min, and the mean estimated blood loss was 180 +/- 194 ml. From the third patient, an ultrasonic surgical system was used and the estimated blood loss decreased significantly. The ultrasonic surgical system, together with a more experienced surgical technique, also cut down the operating times. During surgical intervention, 2 complications occurred; a hemorrhage of more than 500 ml in one patient, and splenic injury in another, which was treated by compression. Postoperative complications occurred in 2 patients; paralytic ileus in one, and abdominal pain due to the pneumoperitoneum in the other. All patients except 2 patients with vertebral fracture began oral intake and ambulation 1 to 4 days postoperatively, and resumed normal daily activity on postoperative day 5 to 7. Compared with the laparoscopic adrenalectomies for the other adrenal tumors, the operating time and estimated blood loss in the Cushing's syndrome patients was not substantially different, though postoperative recovery was slightly longer. When compared with the open adrenalectomies, the operating time was longer, but the postoperative recovery period was significantly shorter. We conclude that with careful surgical intervention, experience of technique, and the introduction of proper equipment, a laparoscopic adrenalectomy for Cushing's syndrome can be performed as less-invasively as a laparoscopic adrenalectomy is for the other adrenal tumors. Furthermore, our findings suggest that laparoscopic adrenalectomy for Cushing's syndrome is likelier to have better postoperative results than conventional procedures, including a more rapid recovery to normal daily activity.

[Clinical experience with laparoscopy-assisted live donor nephrectomy]

PURPOSE

Laparoscopic nephrectomy has become widely performed because of its minimally invasive nature. We have performed laparoscopic nephrectomies for non-functioning kidneys and laparoscopy-assisted radical nephrectomies for renal carcinomas. Recently, we have successfully performed laparoscopy-assisted transperitoneal living related donor nephrectomy for kidney transplantation. To determine the efficacy of laparoscopy-assisted live donor nephrectomy, we investigated the clinical results of 2 patients operated upon with this new operation.

PATIENTS

Case 1 was a 64-year-old healthy male and the left kidney was removed for his son who had a history of 4 months hemodialysis. Case 2 was 67-year-old healthy female who decided to donate her left kidney for her son with the history of 3 years and 2 months hemodialysis.

METHODS

An upper abdominal midline incision of approximately 10 cm in length was made. Two retractors were attached to either side of the midline incision. The abdominal wall was raised by suspending these retractors from a special hanger. Then three trocars were introduced. The Gerota's fascia was incised and the kidney was suspended by grasping the perirenal fatty tissues. The renal artery and vein were carefully isolated without any manipulations of the kidney (non-touch method). After the transection of the ureter, the renal artery was ligated with a free tie of 1-0 silk and a suture ligature of 3-0 silk and the renal vain was clamped with a Satinski forceps. Immediately after the transection of the renal pedicle, the kidney was irrigated and transplanted to the right iliac fossa of the recipient in the usual fashion. A pen-rose drain was placed in the retroperitoneal space and the posterior peritoneal membrane was completely closed with 3-0 silk interrupted sutures.

RESULTS

The mean operating time was 298 minutes and the mean blood loss was minimal. The average time of warm ischemia and cold ischemia of the graft were 4.5 minute and 37 minutes, respectively. There were no complications during either the operation or the postoperative period in both patients. The donors began oral intake and ambulation within 48 hours and resumed their normal daily activities by postoperative day 6.5 on average. Postoperative recovery of the patients were far faster than that of the patients receiving open donor nephrectomy. The graft functions were also excellent. The serum creatinine concentration of the recipients fell down to 0.82 mg/dl and 1.02 mg/dl at the third postoperative day.

CONCLUSION

Laparoscopy-assisted live donor nephrectomy might be advantageous for kidney transplantation because of its minimally invasive procedure.

[Retroperitoneal laparoscopic pelvic lymphadenectomy for patients with prostate cancer]

Between February 1994 and February 1995, we performed retroperitoneal laparoscopic pelvic lymphadenectomy on 7 patients with prostate cancer between 63 and 76 years old, consisting of 6 patients with clinical stage B2, and 1 patient with stage C. Retroperitoneal laparoscopic procedures were performed under general anesthesia. First, the prevesical space was separated by a balloon dissector to create the working space. Then, three trocars were inserted into the retroperitoneal space at the lower abdominal midline. Except for the first patient, only two surgeons were needed to dissect the obturator lymph nodes, under 5 mmHg CO2 insufflation. The mean operating time was 133 minutes for bilateral lymphadenectomy. The mean number of removed lymph nodes was 4.8 on the left side and 4.2 on the right side. The estimated blood loss ranged from 10 to 66 ml. As none of the patients showed node involvement on the microscopic examination of the frozen section, they immediately underwent total prostatectomy. Additionally removed lymph nodes were 0.8 on the left side and 1.5 on the right side. As for intraoperative complications, endotidal CO2 was elevated in the first patient, but the other patients had no complications. Retroperitoneal laparoscopic pelvic lymphadenectomy is a safe and useful procedure, and may facilitate a lymphadenectomy better than a peritoneal procedure.

Purification and characterization of a juvenile hormone binding protein from hemolymph of the silkworm, Bombyx mori

A juvenile hormone binding protein (JHBP) has been isolated from Bombyx mori hemolymph by gel filtration, ion-exchange chromatography, chromatofocusing and hydroxyapatite column chromatography. Gel electrophoresis indicates that the isolated protein is homogeneous in the presence or absence of a denaturing agent. The JHBP in question has a relative molecular mass of 32 kDa, determined by denaturing gel electrophoresis. Chromatofocusing analysis indicated that the JHBP is an acidic protein with pI 4.9. The protein exhibits a dissociation constant of 9.0 x 10(-8) M for JH I, 1.14 x 10(-7) M for JH II and 3.9 x 10(-7) M for JH III, and thus its affinity for JH analogues is in the order of JH I > JH II > JH III. Its amino acid composition indicates that the protein consists of 297 residues of 18 kinds of amino acids. The sequence of the N-terminus of the polypeptide chain was determined for 34 of the first 36 residues: Asp-Gln-Asp-Ala-Leu-Leu- Lys-Pro-?-Lys-Leu-Gly-Asp-Met-Gln-Ser-Leu-Ser-Ser-Ala-Thr-Gln-Gln-Phe-Le u-Glu- Lys-Thr-Ser-Lys-Gly-Ile-Pro-?-Tyr-His-.

[Clinicopathological significance of immune complex (IC) along the tubular basement membrane (TBM) in lupus nephritis]

This paper reports on the clinicopathological significance of IC along the TBM in lupus nephritis. Renal biopsies were performed on 60 patients with SLE. All of the patients demonstrated immunoglobulin deposits in the glomeruli, and 16 of them also showed immune deposits along the TBM. The IgG in the glomeruli or along the TBM completely disappeared after incubation with human IgG, IgG Fc fragments, but not with human F(ab')2, rabbit or rat IgG. These results suggest that IgG along the TBM are similar in nature to IC in the glomeruli and that the IC are composed of IgG rheumatoid factor. The square of tubulointerstitial lesions was more severe in the group with IgG along the TBM than in the group with no IgG along the TBM (5.85 +/- 9.88% vs 1.29 +/- 3.72%). In addition of this, the group with IgG deposits along the TBM frequently demonstrated type IV lupus nephritis. Although the renal function was not significantly different in the both groups, the serum complement level was lower in the cases with IC deposits in the TBM. From these results, it is suggested that IC deposits along the TBM as one of the important inflammatory agents lead to the severe forms of tubulointerstitial injury and show the active stage of the disease in SLE patients.

[Involvement of allergic mechanism in minimal change nephrotic syndrome (MCNS)]

In this study we evaluated the involvement of allergic mechanisms in patients with adult onset MCNS (17 cases) by measuring serum IgE levels and RAST scores to house dust 1 (H.D.1), house dust 2 (H.D.2), Dermatophagoides farinae (D.f.), Dermatophagoides ptenonyssinus (D.p.). Out of the 17 cases, three cases showed high levels of IgE (more than 1000 IU/ml) and the mean level of serum IgE was 877 IU/ml before treatment. All cases were treated with steroid and/or cyclophosphamide. After the treatment, all cases returned to remission. The level of IgE decreased to the normal range in four out of seven cases which had shown high levels of IgE before treatment. RAST was carried out on seven of the 17 cases. RAST scores for D.f. and D.f. were found to be positive in three cases, but these became negative in two cases after treatment. In five cases relapsed, the all cases showed to have the increased level of serum IgE and two of four cases which were examined RAST score showed to have the increased RAST score for D.f. and D.p. Thus, the data indicated that allergic mechanism, especially against D.f. and D.p. antigen, seemed to play one of the factors in the pathogenesis of MCNS.

[Effect of exercise on rats with renal injury]

Effect of exercise on rats with renal injury was studied. Nephritis was induced in rats by injection of anti-GBM antibody followed by ligation of a branch of the left renal artery after nephrectomy of the right kidney. Moderate daily treadmill exercise was forced on these experimental rats for ten weeks. Sedentary nephritic rats that received the same treatment described above served as controls. The sedentary nephritic rats suffered progressively increasing proteinuria during the time course of the experiment, whereas the nephritic rats with daily treadmill exercise experienced less proteinuria. Mild proteinuria was induced by daily treadmill exercise forced on non-nephritic rats that had received only nephrectomy of the right kidney, but no NTS injection. Light microscopy and immunofluorescence microscopy revealed severe glomerular injury in the sedentary nephritic rats, however, less glomerular injury was seen in nephritic rats with treadmill exercise. Serum cholesterol level was higher in the sedentary rats than in the rats with daily treadmill exercise. The results suggest that daily exercise by nephritic rats will not aggravate renal injury.

Purification and characterization of a proline-rich secretory protein that is a precursor to a structural protein of an insect spermatophore

The spermatophore or sperm sac of Tenebrio molitor (yellow mealworm beetle) is an acellular structure composed mostly of structural proteins, termed spermatophorins. The proteins are derived from the bean-shaped accessory reproductive glands of the male and are assembled into the multilayered structure within the ejaculatory duct. Homogenates of the secretory plug from this gland were used as immunogens for the production of monoclonal antibodies, including one identified as PL 21.1 which recognizes an antigen in the gland and the spermatophore. With the aid of gel filtration and immunoaffinity chromatography with a PL 21.1, we isolated a glandular secretory protein that is a precursor to a spermatophorin with similar electrophoretic mobility. On native polyacrylamide gels, the antigen from gland homogenates has an apparent molecular mass of 370 kDa. On sodium dodecyl sulfate gels, the antigen from the gland and that from the spermatophore have apparent molecular masses of 23 kDa. According to immunoblots of sodium dodecyl sulfate gels, the 23-kDa glandular antigen is organ-specific and adult-specific. By immunocytochemistry with PL 21.1, we found the antigens to be restricted to secretory vesicles of only one cell type in the gland and to a discrete layer in the outer wall of the spermatophore. The 23-kDa secretory antigen is distinguished by being high in glutamic acid/glutamine (15.4%) and in proline (25.2%).