Impact of self-decision to stop cancer treatment on advanced genitourinary cancer patients

Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death.We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed.The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group (P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001).Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.

Low-dose Docetaxel Enhanced the Anticancer Effect of Temsirolimus by Overcoming Autophagy in Prostate Cancer Cells

BACKGROUND/AIM

Chemotherapy with docetaxel (DTX) is used for castration-resistant prostate cancer (CRPC), but it is inadequate.

MATERIALS AND METHODS

We evaluated the effect of the combination treatment DTX and the mTOR inhibitor temsirolimus (TEM) in the PC3 prostate cancer cell line, by focusing on the induction of autophagy and apoptosis.

RESULTS

TEM induced autophagy but not apoptosis even at a high dose, whereas DTX induced apoptosis. The combination of low-dose DTX and TEM caused a 34% suppression in cell proliferation compared to monotherapy with a higher dose of DTX. The induction of apoptosis was increased by their combination. The combination with DTX overcame the induction of autophagy by TEM. The combination treatment suppressed tumor growth 72% less than the control group after 14 days of treatment in vivo.

CONCLUSION

The combination of TEM and DTX induced apoptosis by overcoming autophagy and enhanced the anticancer effect compared to monotherapy.

Neurogenic bladder associated with xeroderma pigmentosum type A: A case report and literature review

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary.

Low and high body mass index values are associated with female nocturia

Aims

We evaluated the relationship between body mass index (BMI), including low BMI, and nocturia in Japanese women.

Methods

We collected data on 18 952 women who participated in a multiphasic health screening in Fukui, Japan, in 2006. The participants were asked to report any current or previous disease. Self‐reported current body weight and height were used to calculate the BMI. We analyzed the relationship between nocturia, as assessed by a questionnaire, and other variables including age, BMI, and comorbidities.

Results

The participants’ mean age was 60.6 years. Overall, the prevalence of nocturia (two or more voids/night) was 4.3% and increased in an age‐dependent manner. BMI did not affect nocturia in the young participants. The prevalence of nocturia was higher in the high‐BMI women (>25.0 kg/m ²) in their fifth and sixth decades, but the prevalence was higher in the low‐BMI (<18.5 kg/m ²) in the women more than 80‐years old. A multivariate analysis revealed a significant association between nocturia and the following: age, BMI, sleep disturbance, arteriosclerosis, cerebrovascular disease, chronic pulmonary disease, diabetes mellitus, and hypertension. Not only high BMI (which is already reported as a risk of nocturia) but also low BMI was a factor related to nocturia.

Conclusion

Our findings indicate that in addition to obesity, low BMI is a factor of nocturia in women.

Advanced bladder cancer with malignant psoas syndrome: A case report with a focus on physical findings and complications

Malignant psoas syndrome (MPS) is a rare clinical condition caused by cancer invasion of the iliopsoas muscle and has very poor prognosis. We report a case involving a 58-year-old woman with bilateral MPS caused by advanced bladder cancer. Rapid progress of a severe crouching posture with multiple deep venous thromboses was an important symptom of this case. Although 4 cycles of chemotherapy were administered, the patient died 8 months following disease onset. Since, these noteworthy symptoms have never been previously reported, in this report, we present the characteristic physical findings using photographs and cancer-related events that occur in MPS.

[A CASE OF AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE COMPLICATED WITH HENOCH-SCHÖNLEIN PURPURA NEPHRITIS]

Purpura nephritis and autosomal dominant polycystic kidney disease are relatively rare kidney disorders. We present a case complicated by these two diseases. A 68 year-old man with polycystic kidney disease was referred to our hospital with a high fever lasting 3 days and pyuria. Pyelonephritis was suspected based on computed tomography findings of bilateral swelling of the kidney. Inflammation subsided gradually after the initiation of antimicrobial therapy. However, approximately 3 weeks later, the patient developed a fever and skin purpura on the extremities, stomach colic pain, gross hematuria, and increased proteinuria was evident. Therefore, we diagnosed Henoch-Schönlein purpura complicated with nephritis based on biopsies of the skin and the kidney. Immunosuppressant therapy was administered; every symptom was relieved and proteinuria decreased for approximately 20 months.

Arterial Transit Time-corrected Renal Blood Flow Measurement with Pulsed Continuous Arterial Spin Labeling MR Imaging

Purpose:

The importance of arterial transit time (ATT) correction for arterial spin labeling MRI has been well debated in neuroimaging, but it has not been well evaluated in renal imaging. The purpose of this study was to evaluate the feasibility of pulsed continuous arterial spin labeling (pcASL) MRI with multiple post-labeling delay (PLD) acquisition for measuring ATT-corrected renal blood flow (ATC-RBF).

Materials and Methods:

A total of 14 volunteers were categorized into younger (n = 8; mean age, 27.0 years) and older groups (n = 6; 64.8 years). Images of pcASL were obtained at three different PLDs (0.5, 1.0, and 1.5 s), and ATC-RBF and ATT were calculated using a single-compartment model. To validate ATC-RBF, a comparative study of effective renal plasma flow (ERPF) measured by ^99mTc-MAG3 scintigraphy was performed. ATC-RBF was corrected by kidney volume (ATC-cRBF) for comparison with ERPF.

Results:

The younger group showed significantly higher ATC-RBF (157.68 ± 38.37 mL/min/100 g) and shorter ATT (961.33 ± 260.87 ms) than the older group (117.42 ± 24.03 mL/min/100 g and 1227.94 ± 226.51 ms, respectively; P < 0.05). A significant correlation was evident between ATC-cRBF and ERPF (P < 0.05, r = 0.47). With suboptimal single PLD (1.5 s) settings, there was no significant correlation between ERPF and kidney volume-corrected RBF calculated from single PLD data.

Conclusion:

Calculation of ATT and ATC-RBF by pcASL with multiple PLD was feasible in healthy volunteers, and differences in ATT and ATC-RBF were seen between the younger and older groups. Although ATT correction by multiple PLD acquisitions may not always be necessary for RBF quantification in the healthy subjects, the effect of ATT should be taken into account in renal ASL–MRI as debated in brain imaging.

[A case on hemodialysis with castration-resistant prostate cancer which responded to combination chemotherapy with docetaxel and prednisolone]

A 71-year-old man on hemodialysis was admitted for castration-resistant prostate cancer. He received chemotherapy with docetaxel(60mg/m2 every 3 weeks)and prednisolone(10mg/day). As severe adverse reactions due to chemotherapy were not encountered, he could receive chemotherapy in our outpatient clinic. A total of four courses of chemotherapy resulted in a 56% reduction in PSA, which was judged as PR. Chemotherapy with docetaxel and prednisolone can be safely carried out for a patient with castration-resistant prostate cancer, even while on hemodialysis with the usual dose of docetaxel.

[A case of testicular abscess with low-grade inflammation]

We report a case of testicular abscess with low-grade inflammation. A 55-year-old man was referred to our hospital because of right scrotal pain and swelling for approximately 3 weeks. Physical examination revealed mild tenderness and a hen's egg-sized mass in the right scrotum ; however, fever and scrotal erythema were absent. Magnetic resonance imaging (MRI) showed an enlarged right testis and spermatic cord, and an ultrasonography scan indicated loss of blood flow to these regions. Right testicular necrosis due to spermatic cord torsion or testicular cancer was suspected, and high orchiectomy was performed. However, abscess formation was detected in the testis, and testicular abscess caused by Escherichia coli was diagnosed. The clinical course of this case was unusual because of the small extent of inflammation observed. Typically, testicular abscess is characterized by severe systemic and local inflammation.

Expression of microRNAs associated with Gleason grading system in prostate cancer: miR-182-5p is a useful marker for high grade prostate cancer

BACKGROUND

Expression profiles of some microRNAs (miRNAs) were associated with clinicopathological findings in human prostate cancer (PC), but the relative expression of miRNAs among Gleason patterns (GPs) remains unclear. In this study, we investigated the expression of several known microRNAs in each GP of PC.

METHODS

Formalin-fixed, paraffin embedded (FFPE) tissue samples were obtained from radical prostatectomy (RP) (patient set 1, n = 43, including (GP 3) n = 22, (GP 4) n = 35, and (GP 5) n = 12) and needle biopsy (patient set 2, n = 10, (GP 4) n = 10). Cancer tissues from each GP and adjacent normal counterparts were separately collected using laser-captured microdissection (LCM). Real-time RT-PCR was performed to determine the relative expression of miRNAs, including miR-31-5p, -34c-5p, -96-5p, -182-5p, -183-5p, -205-5p, -221-3p, and -222-3p, which were currently reported to be involved in PC progression.

RESULTS

In radical prostatectomy samples, relative expression of miR-31-5p, miR-34c-5p, and miR-205-5p in any GP was significantly decreased compared to normal counterpart. However, no significant difference was detected among GP 3, GP 4, and GP 5. Meanwhile, in the same GP4, expression of miR-31-5p miR-182-5p, and miR-205-5p in cancer tissues obtained from high grade cancer was significantly higher than those obtained from intermediate grade cancer. Validation study using biopsy samples revealed that the relative expression of miR-182-5p was statistically higher in high grade cancer even in same GP4.

CONCLUSIONS

We confirmed the expression of miR-182-5p depended on the cancer grade even in same GP 4. Expression of miRNA associated with Gleason grading system may contribute to more accurate preoperative cancer risk evaluation.

Tumour multiplicity as a risk factor for the development of bladder tumours after primary upper urinary tract cancer

Objective:

To determine the independent risk factors for intravesical tumour recurrence in patients with primary urothelial cancer of the upper urinary tract.

Patients and methods:

Of the 60 patients who underwent nephroureterectomy for urothelial cancer of the upper urinary tract, the data from 49 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer were excluded from the study. Multivariate analysis by Cox’s proportional hazards model was used to determine independent risk factors for intravesical tumour recurrence.

Results:

Of the 49 patients reviewed, 22 (44.9%) experienced subsequent intravesical tumour recurrence during a mean follow-up period of 26 months (range 3–103). On multivariate analysis, tumour multiplicity had a statistically significant impact on the risk of intravesical tumour recurrence ( P < 0.01).

Conclusion:

Neither the pathology of the upper urinary tract cancers nor the method of treatment was associated with recurrent bladder cancers. Only tumour multiplicity had a significant impact on the incidence of intravesical tumour recurrence.

IPSS is lower in hypertensive patients treated with angiotensin-II receptor blocker: posthoc analyses of a lower urinary tract symptoms population

AIMS

The existence of Angiotensin-II (Ang-II) receptors in the bladder wall and the pronounced contractile effect of Ang-II on the human detrusor muscle have been well established. Studies have presented the role of Ang-II as a mediator in smooth muscle growth and collagen production in the bladder with outlet obstruction. We investigated the associations between male lower urinary tract symptoms (LUTS) and hypertension (HT), and examined whether the medications used for HT treatment, particularly Ang-II receptor blockers (ARBs) influence LUTS.

METHODS

Among 4,298 men with LUTS who were nominated to participate in a Japanese study using the International Prostate Symptom Score (IPSS) to gain information on the effects and the safety of silodosin, a total of 3,790 men for whom a baseline IPSS was available were sub-analyzed. We analyzed the influence of HT treatment on IPSSs.

RESULTS

HT was the most common comorbidity (1,122 men, 29.6%), and 769 men (20.3%) were receiving some kinds of medication for the treatment. We found that the IPSS was lower in patients being treated for HT with ARB than in hypertensive patients who were not receiving any medication (16.8 ± 6.8 vs. 18.3 ± 6.6, P < 0.01). The baseline I-PSS in patients treated for HT with angiotensin converting enzyme inhibitor (ACE-I), calcium channel blocker (CCB), and normotensive patients were 18.3, 19.6, and 18.1, respectively.

CONCLUSION

The IPSS is lower in patients with HT treated with ARB. Other drugs for HT, including ACE-I and CCB, did not improve the IPSS.

Abstract 5033: Relationship between microRNA expression and Gleason grading system in prostate cancer

Background: Recent studies have shown that some microRNA (miRNA) expression profiles are associated with clinicopathological findings, including “Gleason score (GS)” in human prostate cancer (PC). However, the direct relationship between “Gleason pattern (GP)” and miRNA expression remains unclear. In this study, we investigated the miRNA expression profile in each GP (GP 3, GP 4, and GP 5). Methods: Formalin-fixed, paraffin-embedded (FFPE) tissue samples obtained from radical prostatectomy (patient set 1, n = 43, including [GP 3] n = 22, [GP 4] n = 35, and [GP 5] n = 12) and prostate needle biopsy (patient set 2, n = 9, [GP 4] n = 9) were used. Cancer tissues and adjacent normal counterparts were collected separately using laser-captured microdissection with subsequent isolation of total RNA. Real time reverse transcription polymerase chain reaction (RT-PCR) was performed to determine the relative expression of miRNAs, including miR-31, -34c, -96, -182, -183, -205, -221, and miR-222, which are currently reported to be involved in the progression of PC. Results: In the radical prostatectomy samples (patient set 1), relative expression (mean ± SE) of miR-31, miR-34c, and miR-205 in every GP was significantly decreased (miR-31: [GP 3] 0.028 ± 0.007, [GP 4] 0.047 ± 0.017, and [GP 5] 0.071 ± 0.022; miR-34c: 0.208 ± 0.066, 0.419 ± 0.219, and 0.210 ± 0.054; and miR-205: 0.021 ± 0.008, 0.015 ± 0.003, and 0.050 ± 0.023, all p-values &lt; 0.01) compared to normal counterparts. However, there was no significant difference between GP 3, GP 4, and GP 5. Meanwhile, in GP4, expression of miR-31, miR-182, and miR-205 in tissues obtained from high-grade cancer (GS 8 or GS 9) were significantly higher than those in tissues obtained from intermediate-grade cancer (GS 7) (miR-31: [high grade] 0.071 ± 0.027, [intermediate grade] 0.011 ± 0.003, p = 0.040; miR-182: 1.745 ± 0.278, 0.864 ± 0.136, p = 0.021; and miR-205: 0.022 ± 0.005, 0.005 ± 0.002, p = 0.002, respectively). Validation testing of biopsy samples (patient set 2) revealed that the relative expression of miR-182 was similarly and significantly higher in high-grade cancer tissue (high grade: 1.863 ± 0.381, intermediate grade: 0.717 ± 0.196, p = 0.043). Conclusion: The expression of miR-182 differed by cancer grade even in the same GP 4, and this difference was detected in both biopsy and radical prostatectomy samples. Our findings suggest that evaluations of miRNA expression with respect to Gleason grading in biopsy samples may contribute to more accurate preoperative cancer risk evaluation.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5033. doi:1538-7445.AM2012-5033

[Advanced sarcomatoid renal cell carcinoma effectively treated with sunitinib: report of a case]

We report a case of advanced sarcomatoid renal cell carcinoma (RCC) effectively treated with sunitinib. A 77-year-old female who had gross hematuria and left lower abdominal pain was found to have a left renal tumor by computed tomography (CT) and was referred to our hospital. CT revealed a poorly enhanced mass in the left kidney and an enlarged paraaortic lymph node. The patient underwent laparoscopic left nephrectomy, and the tumor was histologically diagnosed as a sarcomatoid RCC. Sunitinib was administered to treat lymph node metastasis, postoperatively, and a partial response was observed after 4 courses. Sunitinib administration has been continued without tumor re-growth.

Regulation of microRNA expression by hepatocyte growth factor in human head and neck squamous cell carcinoma

Hepatocyte growth factor (HGF) is a multifunctional molecule that acts as mitogen, motogen, and/or morphogen in a variety of cells. MET, a specific receptor tyrosine kinase for HGF, is upregulated in various tumors including squamous cell carcinoma of the human head and neck (HNSCC), but how HGF affects the expression of downstream functional genes has not yet been elucidated in detail. In the present study, we examined the expression of microRNA (miRNA), non-coding small RNA that regulate cell proliferation and functions by interfering with the translation of target mRNA, with or without HGF stimulation in HNSCC cell line HSC3. Among several miRNAs, in which the expression was altered after HGF stimulation, we focused on miR-200c and miR-27b, both of which were drastically downregulated after HGF stimulation. Expression of ZEB1, a target mRNA for miR-200c, was upregulated 3 and 6 h after HGF stimulation, and that of E-cadherin, a downstream molecule of ZEB1, was downregulated 12 h after HGF stimulation. Expression of ST14/matriptase, an enzyme for extracellular matrix (ECM) degradation and HGF activation and a target mRNA for miR-27b, was drastically upregulated in the protein level after HGF stimulation, although it was not statistically altered in the mRNA level. These results suggest that miR-200c and miR-27b downregulated by HGF might play an important role in epithelial-mesenchymal transition mediated by ZEB1/E-cadherin and ECM degradation and HGF autoactivation mediated by ST14/matriptase, respectively. Altered expression of miRNA directly regulated by HGF might contribute enhanced progressive and invasive characteristics of HNSCC by regulating the translation of HGF-induced functional molecules.

Urethral Sensations are Related to the Development of Detrusor Overactivity

Urgency is the core symptom of the overactive bladder symptom complex, but the underlying mechanisms are not fully understood. Clinical findings have led to the assumption that bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE) induces storage symptoms and detrusor overactivity. Presumably, BOO by BPE accounts for urgency; however, urgency is not always caused by BOO. Sensory nerves in the wall of the urethra fire in response to urethral fluid flow, and this activity initiates bladder contractions in the quiescent bladder and augments ongoing contractions in the active bladder. In humans, prostatic urethral anesthesia results in significant increases in bladder capacity among BPH patients without neurological diseases, therefore sensory stimuli from an anatomically altered prostatic urethra has the possibility to induce urgency and detrusor overactivity. Studies in animals demonstrate the basis for an excitatory urethra to bladder reflex. Urethral stimulation by prostaglandin E2 induces an excitatory effect on micturition reflex by activation of C-fiber afferent nerves. α1A -adrenoceptor blocker has an inhibitory effect on the micturition reflex, suggesting excitatory urethra to bladder reflex is mediated by α1A -adrenoceptor. Even if there is no obstruction, increase in urethral sensory due to BPE may induce the development of the detrusor overactivity.

Abstract 3972: Regulation of microRNA expression by hepatocyte growth factorin human head and neck sqaumous cell carcinoma (HNSCC)

Introduction: Hepatocyte growth factor (HGF) is a multifunctional growth factor that acts as mitogen, motogen, and/or morphogen in a variety of cells. MET, a specific receptor tyrosine kinase for HGF, is up-regulated in various tumors including human head and neck squamous cell carcinoma (HNSCC) and its signal transduction induces tumor progression and invasion. However, how HGF affects the expression of downstream functional gene expression has not yet been elucidated in detail. MicroRNAs (miRNAs) are non-coding small RNAs that regulate posttranscriptional gene expression by interfering the translation of target mRNAs. Aberrant expression of miRNA is known to induce various human tumors including HNSCC, but the regulation of miRNA expression is still unknown. In this study, we examined the expression of miRNAs with or without HGF stimulation in human HNSCC cell line HSC3 and the expression of their putative target genes was evaluated. Methods: Human HNSCC cell line HSC3 was cultured with or without HGF for designated periods. Alteration of miRNA expression was examined by miRNA microarray analysis. Validation study of miRNAs showing altered expression was performed by quantitative RT-PCR (qRT-PCR). The expression of putative target mRNAs and their translated proteins were examined by qRT-PCR and western blot analysis, respectively. Results: The expression of several miRNAs including let-7a, miR-16, and miR-205, which are already known as tumor-suppressive miRNAs, was altered after HGF stimulation by miRNA microarray. Among them, we focused on miR-200c and miR-27b which were drastically down-regulated after HGF stimulation, because of their unique target mRNAs involving HGF-mediated functional molecules. The expression of ZEB1, a target mRNA for 200c, was up-regulated 3hr after HGF stimulation and that of E-cadherin, a downstream molecule of ZEB1, was up-regulated 12hr after HGF stimulation. The expression of ST14/matriptase, an activation enzyme of HGF and a target mRNA for miR-27b, was not statistically altered after HGF stimulation, but the protein level was drastically up-regulated 12hr after HGF stimulation. These changes were attenuated in part by the addition of oligo pre-mi27b or pre-miR200c into the culture medium. Conclusion: Our present results suggest that miR-200c down-regulated by HGF might play an important role for epithelial-mesenchymal transition (EMT), through up-regulation of ZEB1 followed by down-regulation of E-cadherin. In addition, it was also suggested that miR-27b down-regulated by HGF might induce auto-activation of HGF in HNSCC. These alterations of miRNA expression by HGF stimulation could be induce the enhanced progressive and invasive characteristics of HNSCC. This is a first report that HGF may directly regulate some miRNAs that affect the expression of HGF-mediated downstream functional molecules.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3972. doi:10.1158/1538-7445.AM2011-3972

[Investigation of urinary management after removal of indwelling urethral catheters in a general hospital: associations between bedridden state and impaired bladder emptying]

In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients,on lower urinary tract dysfunction and urinary management during hospital care. All 1,106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%,non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group,many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying,and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

[Mixed epithelial and stromal tumor of the kidney: a case report]

We report a case of a mixed epithelial and stromal tumor of the kidney. A 64-year-old female who had no complaint was found to have a left renal tumor by computed tomography (CT) for an examination of a right breast tumor and was referred to our department. CT revealed a gradually enhancing 5 cm mass in the left kidney. The patient underwent left radical nephrectomy, and the tumor was histologically diagnosed as a mixed epithelial and stromal tumor. The patient has been followed up for 6 months with no evidence of local recurrence or metastasis.

Serotonin syndrome during clomipramine monotherapy: comparison of two diagnostic criteria

Incidence of serotonin syndrome was determined by two different diagnostic criteria during clomipramine monotherapy. Incidence, determined by Sternbach's criteria, was 12.1% (8/66 patients), and that determined by the criteria of Dursun et al. was 3.0% (2/66 patients). The two patients who met the latter criteria also met the former criteria. The lower incidence with the latter was attributable to the fact that it does not include certain symptoms, such as tremors and diaphoresis, which are included in the former, and were seen in a relatively large number of patients; as well as the fact that the latter more strictly define certain symptoms. Both criteria have pros and cons. Sternbach's diagnostic criteria make it possible to diagnose serotonin syndrome in a wider range of patients, but they sometimes make it difficult to make it differential diagnosis in the presence of certain limited symptoms. In contrast, the criteria of Dursun et al. may make a more accurate diagnosis possible, though only in severe cases.

Development of hydrosalpinx during ovulation induction

We have observed that hydrosalpinx develops in some patients undergoing ovulation induction as part of in vitro fertilization-embryo transfer and gamete intrafallopian transfer programs. Increased tubal secretions due to multihormonal stimulation causes a blocked tube to distend by the time of oocyte harvest. In a subset of women, hydrosalpinx was not identified on initial pelvic sonograms. Hydrosalpinx became apparent during serial sonography to monitor follicular development. We performed a retrospective chart review of these cases in order to confirm this finding with hysterosalpingography or laparoscopy. Nine of 316 women developed unilateral (eight cases) or bilateral hydrosalpinx (one case) during stimulation. Recognition of this sonographic finding is important to the referring physician because it has important therapeutic and outcome implications.

Effects of 8-OH-DPAT on corticosterone after acute and chronic administration of antidepressants

1. Serotonin has a facilitary role in the role of corticosterone secretion. 8-Hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), a selective 5-HT1A agonist, dose dependently (0.25- 1.0 mg/kg i.p.) increased rat plasma corticosterone concentration. 2. 3 days parachlorophenylalanine (PCPA) (150 mg/kg) administration did not effect the 8-OH-DPAT-induced corticosterone secretion. 3. Corticosterone responses to 8-OH-DPAT (0.5 mg/kg) were significantly attenuated by pretreatment with propranolol (5 mg/kg). Ketanserin (2 mg/kg), haloperidol (0.2 mg/kg), prazosin (0.1 mg/kg), and ICS-205930 (30 mu/kg) failed to antagonize the corticosterone response to 8-OH-DPAT. 4. 8-OH-DPAT-induced corticosterone were investigated in male rats after treatment with mianserin (2, 10 mg/kg), imipramine (5 mg/kg), desipramine (5 mg/kg), doxepine (5 mg/kg) for 1 day or 3 weeks. Chronic mianserin (10 mg/kg) and doxepine (5 mg/kg) did significantly increase 8-OH-DPAT-induced corticosterone response. Acute antidepressant, chronic imipramine, desipramine and mianserin (2 mg/kg) treatment did not change it. 5. These findings demonstrate that chronic treatment of some antidepressants potentiates 8-OH-DPAT-induced increase in plasma corticosterone, by actions at 5-HT-1A receptors located postsynaptically on 5-HT neurones.

A method for analyzing biological rhythms in healthy subjects and depressed patients

Rectal temperature rhythms of healthy subjects and patients with depression were fitted to a waveform having cosine components of periods 8, 12, and 24 hours using the least squares method. The nadir was then used as an index of phase. The results suggest that this method gives more exact data than the conventional method of analyzing biological rhythms, which uses a least squares fit to a single, 24-hour-period cosine waveform.

[Adverse effects of antidepressants and anti-manics/mood stabilizers]

Information on the adverse effects of antidepressants and antimanics/mood stabilizers is presented. The adverse effects of antidepressants include pharmacological side-effects, toxic effects, interactions with other drugs, withdrawal syndrome and "jitteriness" syndrome. The most common adverse effects with lithium treatment are polyuriapoly-dipsia, hypothyroidism, gastrointestinal symptoms, psychological complaints and ECG changes. The adverse effects of carbamazepine and valproate are mild and readily manageable, however problems associated with the hepatic system, the hematopoietic system and the thyroid gland, are important. It seems that no major deficits have been identified in studies of tricyclic antidepressant teratogenicity. Lithium, carbamazepine and valproate carry significant teratogenic effects.

The effect of chronic administration of antidepressants and electroconvulsive shock on the 5-HT1A receptor mediated hypothermic response induced by 8-OH-DPAT in the rat

1. The effect of chronic administration of antidepressants and electroconvulsive shock (ESC) on the hypothermic response (HTR) induced by 8-hydroxy-2-(di-n-propyramino) tetralin (8-OH-DPAT) as an index of the function of 5-HT1A receptors was investigated in the rat. 2. 8-OH-DPAT dose-dependently decreased the rectal temperature. 3. Pretreatment with parachlorophenylalanine increased HTR. 4. Chronic administration of the antidepressants, trazodone, imipramine, amitriptyline, and fluoxetine had no effect on HTR, whereas administration of clorgyline attenuated HTR significantly. 5. Repeated ECS had no effect on HTR. 6. These results suggest that the action site of 8-OH-DPAT is post-synaptic 5-HT1A receptors and that the chronic administration of some antidepressants and ECS has no direct action on these receptors. 7. Therefore, the antidepressant effects of these drugs are not produced by direct action on postsynaptic 5-HT1A receptors.

Effects of chronic mianserin administration on serotonin metabolism and receptors in the 5-hydroxytryptophan depression model

1. To further investigate a previous postulate that increased serotonergic activity may cause depression, the effects of chronic mianserin administration on 5-HT, its metabolites, and the subtypes of 5-HT receptors were studied. 2. The levels of 5-HT, 5-hydroxyindoleacetic acid, 5-HTP, 5-HT turnover and their response to 5-HTP administration all exhibited no change following mianserin treatment. 3. The Bmax value of the high affinity site of the 5-HT-1A receptor increased and the Bmax value of 5-HT-2 receptor decreased with no change in the low affinity site of the 5-HT-1A receptor nor in the 5-HT-1B receptor. 4. The response to 5-HTP administration showed no change in any of these receptors. 5. These results suggest that the chronic mianserin administration might block both the 5-HT-2 and 5-HT-1A receptors in the 5-hydroxytryptophan depression model.

Effect of IAP and chronic antidepressant administration on the 5HT1A receptor in rat cortical membranes

1. A possible coupling of the rat cerebral cortex 5-hydroxytryptamine (5HT)-1A receptors to isletactivating protein (IAP, pertussis toxin) sensitive Gi protein was investigated by studying the effects of a guanosine 5'-triphosphate (GTP) and IAP injection to the rat ventricle. 2. Scatchard analysis showed that Bmax value of the high-affinity componentin [3H]8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) binding was decreased by pretreatment with IAP. 3. GTP caused a significant decreased Bmax of the high affinity site for [3H]8-OH-DPAT binding. It was noted that the IAP suppressed the cyclic AMP production by 5HT, VIP and Forskolin. 4. These results suggest that the rat cortex 5HT-1A receptors are linked to the Gi protein. 5. After 3 weeks chronic administration of amitriptyline (5mg/kg), desipramine (5mg/kg), imipramine (5mg/kg), doxepin (5mg/kg) and trazodone (10mg/kg), the receptor binding assay was carried out on 5HT-1A receptors. 6. It was observed that all the antidepressant drugs except for imipramine increased the number of high-affinity sites of the 5HT-1A receptors in the frontal cortex. 7. These results suggested that the increase of the Bmax for the 5HT-1A receptor might be related to the effectiveness of the antidepressant drugs.

Animal study on the role of serotonin in depression

1. In our series of experiments the role of serotonin in human depression was studied by using animal models of depression. 2. The results of these studies support the hypothesis that some types of human depression may be primarily due to an excessive transmission of serotonin at the synapse.

Circadian rhythm of serotonin receptor in rat brain

Bmax and Kd for the serotonin receptors (5-HT-1) as well as the ratios of 5-HT-1A and 5-HT-1B receptors were assessed at 3-hour intervals over a 24-hour period in the cortex of rats that were housed under a 12-hour lighting cycle, with the light turned on at 18:00. The circadian rhythm of the Bmax for the high- and low-affinity sites in 5-HT-1 receptor became evident. The peak of the Bmax for the high- and low-affinity sites occurred between 21:00 and 00:00. No circadian rhythm was observed for Kd at each site for the 5-HT-1 receptors. The ratios of Bmax for the high- and low-affinity sites of the 5-HT-1 receptors were constant at 8.6 +/- 1.4% and 91.4 +/- 1.4% respectively over the test period. The ratios of 5-HT-1A and 5-HT-1B receptors were constant at 36.8 +/- 1.3% and 63.2 +/- 1.2% respectively over the test period. No circadian rhythm was observed for Kd. These results suggest that the Bmax for the 5-HT-1 receptors may have the same circadian rhythm as high- and low-affinity sites and the Bmax for the 5-HT-1A and 5-HT-1B receptors may also have circadian rhythm.

[Second report of ofloxacin: clinical study]

We previously reported a study on the antimicrobial action of a chemically synthesized drug, ofloxacin (OFLX) and on its transfer in. This paper describes the results of our clinical study on OFLX. 1. Only small fractions of intra-blood OFLX were transported into female organs such as uterus, ovary and fallopian tube. Our study with the normal delivery method shows that umbilical cord blood concentrations of OFLX is a third to a sixth of maternal blood concentrations and is achieved through trans-placental transfer. Its transfer into amniotic fluid, however, is very low. 2. Forty-one cases, including cases of female intrapelvic inflammation, urinary tract infection, puerperal mastitis, etc., were administered with OFLX at levels of 200 approximately 400 mg/day for 3 approximately 10 days. OFLX were found to be effective in 35 cases. 3. We observed 113 cases to which OFLX was administered, and found only 4 cases of gastrointestinal disturbance and 1 case of suspicion of drug eruption as side effects. Laboratory tests showed no abnormalities due to OFLX in blood, serum biochemical or urine value in the cases examined (26 to 51 cases depending on test).

[Per rectal administration of antibiotics. Clinical use of ampicillin in respiratory tract infection in children]

As one of our clinical studies on per rectal administration of antibiotics, children who suffered respiratory tract infection (RTI) were administered with ampicillin (ABPC) through this route. Our conclusions drawn from this study are as follows: 1. One hundred and eighty strains of aerobic bacteria which were isolated by us in 1984-1985 were tested for the sensitivity to ABPC using plate-disk method. MIC's of ABPC for all the strains of Streptococcus pyogenes were lower than 0.024 micrograms/ml. MIC's for all the strains of Streptococcus haemolyticus were 0.05-0.20 microgram/ml. MIC's for 88% of the strains tested of Haemophilus influenzae were 0.10-0.78 microgram/ml. 2. Bacterial flora in the respiratory tract of 97 cases of children, who suffered RTI, were cultured. Almost half of them were Gram-positive cocci, the rest belonged to Gram-negative groups. This indicates that broad-spectrum antibiotics should be chosen first even before the diagnosis of causative organisms is established. 3. Soon after a per rectal administration of ABPC to children, high blood concentrations of the drug were observed by paper-disk method. 4. Eleven cases, which included 2 cases of pneumonia, of 15 children who suffered RTI and were given this antibiotic were greatly improved within 3-10 days. No serious side effects were observed. 5. Our brief study reported here indicates that ABPC administration by rectal route is safe and useful for the clinical treatment of RTI of children.