[Tuberous sclerosis associated with renal angiomyolipoma, pulmonary lymphangioleiomyomatosis and subungual fibroma: report of a case]

We report a case of tuberous sclerosis associated with bilateral renal angiomyolipomas (AMLs), pulmonary lymphangioleiomyomatosis (LAM) and subungual fibroma of hands and feet. A 42-year-old woman who was diagnosed as tuberous sclerosis at the age of 18 complained of left flank pain and abdominal fullness. Bilateral renal AMLs were pointed out when complete examinations were performed for hypertension at the age of 32. She suffered from severe left flank pain and abdominal distension due to the left renal tumor. Left nephrectomy and excision of the renal hilar tumor were performed. The left renal tumor weighed 1120 g, the perirenal space was filled with the tumor. histopathological diagnosis of the left renal tumor and renal hilar tumor was AML. In our case, bilateral pneumothorax appeared, and chest CT scan revealed bilateral multiple pulmonary cysts. Histopathological diagnosis of pulmonary cysts was LAM. Other complications of our case are intracranial calcification and adenoma sebaceum.

Antitumor killer lymphocytes in the peripheral blood of a patient with transitional cell carcinoma of the bladder

BACKGROUND

Peripheral blood lymphocytes (PBL) from patients with bladder cancer also contain cells possessing cytotoxic activity against autologous tumor cells. These cells are phenotypically heterogenous and include natural killer (NK) and cytotoxic T cells. This study investigated the role of cytotoxic lymphocytes directed against autologous bladder cancer cells.

METHODS

PBL were obtained at intervals before and after surgery and analyzed for cytotoxic activity against autologous bladder cancer cells in 4-hour 51Cr release assay. PBL stimulated with autologous tumor cells were also transformed with human T-lymphotropic virus type-1, establishing a cell line (KB31) which was analyzed for phenotype and cytotoxic activity against the autologous tumor cells.

RESULTS

PBL preoperative cytotoxic activity was low, but increased after surgery. Cytotoxic activity was found not only against autologous bladder cancer cells, but also against heterologous bladder cancer (KK-47) and myeloid leukemia (K562) cells, with the highest activity against the heterologous cell lines. The cytotoxic activity of KB31 was 40% against autologous tumor cells 6 weeks after initiation of the cell line, but decreased to 5% by 6 months. This activity was lower than that against the other cell lines, and was similar to that of PBL in short-term culture. Fluorescence-activated cell sorter (FACS) analysis demonstrated that in KB31 cells at 6 weeks, CD8+ cells were dominant, but CD56+ cells predominated at 6 months.

CONCLUSION

These results suggest that the presence of cytotoxic activity in the peripheral blood of the patient was due to both cytotoxic T cells and NK cells. The cytotoxic activity was lowest prior to surgery and increased postoperatively.

[A case of pyelitis cystica diagnosed with utilization of ureterofiberscope]

We herein report a case of pyelitis cystica in 65-year-old woman. She was referred to our hospital in order to have a treatment for a stone in the ureter on left side. Excretory urogram showed hydronephrosis on left, and multiple, small, smooth and round filling defects in the renal pelvis on right side. ESWL was performed to the ureteral stone, and the stone was discharged completely in 4 days. Then further examinations were made for the filling defects of right renal pelvis. Nonopaque calculi were ruled out on retrograde pyelogram and CT scan. Urinary cytology from the renal pelvis was class I. Our impression was pyelitis cystica of right kidney. Under spinal anesthesia, ureterofiberscopy was performed. Multiple small cysts were observed in the pelvis and calyx, as well as cystitis cystica. Cold cup biopsy was also done and histopathological finding ws pyelitis cystica, without malignancy. We compared endoscopic findings with radiographic findings in 18 cases of pyloureteritis cystica from the Japanese literature. The radiographic findings were multiple small, in a uniform size, and round filling defects with regular contour, and the endoscopic findings were multiple white or ocher colored, half sphere or sphere shaped, and small cyst with smooth surface in 15 of 18 cases. We thought these findings were characteristic ones in pyloureteritis cystica. Endoscopy and biopsy are mandatory for diagnosis of pyeloureteritis cystica.

Relationship between area under the concentration versus time curve of cyclosporin A, creatinine clearance, hematocrit value, and other clinical factors in Japanese renal transplant patients

We evaluated the relationship between the area under the concentration versus time curve (AUC) of cyclosporin A (CsA) and several other clinical factors, because the clinical utility of AUC monitoring has been ambiguous. Fifty-four clinical time courses from 14 Japanese renal transplant patients during hospitalization, in the period from April 1990 to March 1997, were examined. In a bivariate regression analysis there was no correlation between the AUC and the daily dose of CsA (mg/kg/day) when the individual data or total series data were analyzed. In a chi-square test, the donor type of kidney (chi(2) = 25.254, df = 1, p = 0.0000) and renal function-related episodes, i.e. acute tubular necrosis, hemodialysis, hypertension, nephrotoxicity, or rejection (chi(2) = 13.982, df = 1, p = 0.0002) directly affected posttransplant renal function assessed by creatinine clearance, while episodes of hepatic function as assessed by the glutamate-pyruvate transaminase (GPT) activity level had no correlation with the posttransplant renal function evaluated according to creatinine clearance. In contrast, the renal function-related episodes significantly affected the AUC after renal transplantation (chi(2) = 4.934, df = 1, p = 0.0263), while hepatic function assessed by GPT did not. In a multivariate analysis, the creatinine clearance and obesity had significant positive correlations with the AUC, whereas the hematocrit had a significant negative correlation with the AUC. From these observations, we concluded that the dosage adjustment of CsA cannot be performed using the linear relationship between the daily oral dose and the AUC, and that renal function, obesity, and the CsA blood distribution properties affect the CsA pharmacokinetics after renal transplantation. Posttransplant renal function as well as obesity and CsA blood distribution properties are important factors to be considered when therapeutic monitoring is performed.

Increase of growth-associated protein-43 immunoreactivity following cyclophosphamide-induced cystitis in rats

We examined the effect of inflammation on immunoreactivity of growth-associated protein (GAP-43) in the rat urinary bladder in which acute cystitis was induced with cyclophosphamide (CPA). Following CPA injection, the number of GAP-43 labeled nerves was significantly increased in the muscle layer. Immunoreactivity of PGP9.5, which was used as an axonal marker, was not augmented following CPA injection. Double fluorescence immunohistochemistry revealed that substance P immunoreactivity was present in most GAP-43 immunoreactive fibers (90.2%) in the inflamed bladder. Electron microscopic examination showed that GAP-43 immunoreactivity was localized on axons. Some GAP-43 positive axons showed degeneration. Possible significance of the increase of GAP-43 immunoreactive afferent nerve fibers in the muscle layer of acutely inflamed bladder was discussed.

[Adenocarcinoma of the bladder 19 years after the augmentation ileocystoplasty: report of a case]

We report a case of adenocarcinoma of the augmented bladder 19 years after ileocystolasty. The patient was a 53-year-old man who underwent right nephrectomy and ileocystoplasty (Pyrah's method) for contracted bladder due to tuberculosis in 1965. In another hospital, transurethral resection (TUR) was performed against a tumor in the anastomotic site between the bladder and the ileal segment in 1996. Histopathological examination of the specimen obtained by TUR revealed poorly-differentiated mucinous adenocarcinoma. In our hospital, partial cystectomy with total resection of ileal segment and ileocystoplasty were performed. The tumors located in the anastomotic site between the bladder and ileal segment as well as in the ileal segment. Histopathological examination revealed poorly-differentiated mucinous adenocarcinoma. The patient has survived 12 months without any evidence of tumor recurrence. To our knowledge, this is the eighth case report in Japan.

Azathioprine-induced megaloblastic anemia with pancytopenia 22 years after living-related renal transplantation

Macrocytosis and megaloblastic changes in the bone marrow are frequently seen in renal transplant recipients treated with azathioprine (Az). However, severe anemia is a rare side effect of Az. We recently observed a case of severe megaloblastic anemia with pancytopenia in a renal transplant recipient who had been receiving Az therapy for 22 years. The patient was a 46-year-old woman who had been administered Az and prednisolone at a dose of approximately 1.7 mg/kg and 0.17 mg/kg daily, respectively. A bone marrow aspiration revealed megaloblastic anemia with the depletion of myeloid cells and megakaryocytes. She did not have vitamin B12 or folate deficiency. Therefore, FK506 (tacrolimus), a macrolide produced by Streptomyces tsukubaensis, which acts directly on T cells and is known to have less myelosuppression than Az, was substituted for Az. Although the leukopenia improved, the anemia and thrombocytopenia did not improve in the short term. She developed dyspnea and severe subcutaneous bleeding of the right lower extremity due to knee contusions. Hemodialysis was started to treat her uremic state. Although it was impossible to evaluate the long-term effects of FK506 therapy for the pancytopenia in our case, the conversion from Az to a less myelosuppressive drug, such as FK506, should be considered in renal transplant recipients with severe myelosuppression caused by long-term Az treatment.

Nephron sparing surgery for de novo renal cell carcinoma in an allograft kidney: a case report

De novo renal cell carcinoma in a renal allograft is rare and has special implications in renal transplant recipients. We describe a patient with a renal allograft who developed a de novo renal cell carcinoma in the functioning renal allograft 258 months after transplantation. The patient underwent enucleation of the tumor because preoperative MRI showed it was well-encapsulated. A DNA banding study showed that the tumor originated from the donor. Indications for conservative renal surgery in renal cell carcinoma have been increasing. Accordingly, 1 option in the treatment of de novo renal cell carcinoma in a functioning renal allograft is enucleation as a method of nephron sparing surgery.

[Adenocarcinoma occurring 37 years after augmentation ileocystoplasty for tuberculous bladder atrophy: report of a case]

A 55-year-old woman was admitted with urinary frequency. She had undergone augmentation ileocystoplasty due to tuberculous bladder atrophy 37 years previously. Cystoscopy revealed a tumor on the posterior wall which had been augmented with the ileum. Partial cystectomy and bladder reconstruction using a segment of ileum and ascending colon were performed. Gross inspection showed a 15 x 10 mm, papillary tumor on the ileal mucosa near the vesico-ileal anastomosis. Histologically, moderately differentiated adenocarcinoma infiltrating into the muscle layer was surrounded by the normal ileal mucosa. She has been free of recurrence for 2 years postoperatively. This is the 8th case of adenocarcinoma following augmentation ileocystoplasty reported in the Japanese literature.

Intra-operative autotransfusion in radical cystectomy

OBJECTIVE

To assess the feasibility of intra-operative autotransfusion (IAT) as a method of decreasing or avoiding homologous blood transfusion during radical cystectomy.

PATIENTS AND METHODS

IAT was performed in 10 patients with bladder cancer who underwent radical cystectomy. The patients were divided into two groups: group 1 consisted of six patients without and group 2 of four patients with pre-deposited blood. Blood shed in the operative field was collected and processed with an IAT device.

RESULTS

In group 1, the intra-operative blood loss ranged from 1.08 to 2.67 L (mean 1.82) and homologous blood transfusion ranged from 0 to 1 L (mean 0.47). The amount of autologous blood processed and transfused by the IAT device ranged from 0.38 to 0.98 L (mean 0.64). Two patients did not require homologous blood transfusion. In group 2, the volume of pre-deposited blood ranged from 0.8 to 1.2 L (mean 0.9). The intra-operative blood loss ranged from 1.03 to 3.24 L (mean 1.8). The amount of processed autologous blood transfused ranged from 0.4 to 0.6 L (mean 0.45). None of the patients in group 2 required homologous blood transfusion.

CONCLUSION

Although there are theoretical risks with IAT, they were not substantiated by the clinical data. IAT seems to be a feasible method of reducing or avoiding homologous blood transfusion in radical cystectomy. These results suggest that IAT in combination with pre-deposited blood will abolish the need for homologous blood transfusion during radical cystectomy.

Menkes' kinky hair disease associated with a large bladder diverticulum: a case report

We report a 2 year-old boy with Menkes' kinky hair disease associated with a solitary huge bladder diverticulum. To our knowledge this is the first reported case treated successfully by surgical excision under general anesthesia, which has been previously considered hazardous due to the poor general condition of the patient.

Assessment of the availability of intraoperative autotransfusion in urological operations

PURPOSE

Intraoperative autotransfusion in urological operations has the risks of reinfusing urine constituents, bacteria and cancer cells. We assessed the efficacy of intraoperative autotransfusion and leukocyte removal filters to separate red blood cells from these constituents.

MATERIALS AND METHODS

Concentrated red blood cells were mixed with urine, bacteria (Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae) and tumor cells (KK47 and ACHN), and processed with the intraoperative autotransfusion device. Biochemical analyses of erythrocytes collected in reinfusion bags (collected erythrocyte solution) from the mixtures of concentrated red blood cells and urine (mixture 1), and cultures of collected erythrocyte solution from the mixtures of concentrated red blood cells and bacteria (mixture 2) were performed. Cytology was done on collected erythrocyte solution from the mixtures of concentrated red blood cells and tumor cells (mixture 3) and filtrates were passed through leukocyte removal filters.

RESULTS

Biochemical analyses of collected erythrocyte solution from mixture 1 indicated complete removal of urine constituents, while cultures from mixture 2 yielded bacterial growth. Tumor cells from both cell lines were found in the collected erythrocyte solution from mixture 3 although tumor cells were not found in filtrates through leukocyte removal filters.

CONCLUSIONS

Our results suggest that intraoperative autotransfusion is safe for urological operations in which bacteria and tumor cells are not present in the operative field. Our data also indicate that intraoperative autotransfusion may be safe for urological cancer operations if it is combined with leukocyte removal filters to prevent unexpected reinfusion of tumor cells.

[Hemo-lymphangioma of the scrotum: a case report]

A 3-year-old boy was referred because of a painless mass in the left scrotum. On palpation, the mass was discriminated from the testis, epididymis and spermatic cord and showed transillumination. A part of the mass was dark purple in color. Total surgical excision of the mass was performed. The lesion was multicystic (2-15 mm), adherent to the scrotal skin, and easily dissectable from the testicle. Pathological examination revealed lymphangioma as a major component and hemangioma as a minor part. He has been free of recurrent disease for 2 years. This is the 7th case of hemo-lymphangioma of the scrotum in the Japanese literature.

Clinical experience of orthotopic urinary reservoirs in male patients with bladder cancer

Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.

[Experimental bladder stone production by human uropathogenic bacteria]

To investigate the formation of infection stones by 5 bacterial species isolated from patients with urinary calculi, such as Proteus mirabilis, Staphylococcus saprophyticus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, a zinc disc was implanted and 10(6) bacteria were surgically inoculated at the same time into the bladder of male Wistar rats (10 rats per group). Urinary pH was measured on days 1, 3, 5 and 7. The rats were killed on day 7 and the bladder examined for the formation of infection stones. Infection stones were formed in all rats inoculated with P. mirabilis (mean stone weight 29.7 mg), and in 60% of those inoculated with S. saprophyticus (9.7 mg). Small bladder stones were formed in 30% of the rats inoculated with K. pneumoniae and 25% of those inoculated with P. aeruginosa. No bladder stones were formed in the rats inoculated with E. coli. Urinary pH was increased by P. mirabilis and S. saprophyticus but was unaffected by the other species. In conclusion, P. mirabilis and S. saprophyticus play a significant role in the formation of infection stones.

[Immunohistochemical study on endothelin in rat kidney]

To elucidate the role of endothelin (ET) in the kidney, we immunohistochemically examined the precise distribution of various forms of ET-peptides in the rat kidney, using specific polyclonal antibodies to each precursor (Big ET-1, Big ET-2 and Big ET-3), and anti-mature ET antibodies. Immunoreactivity of Big ET-1 was localized mainly in some vascular endothelial cells, glomerular mesangial cells and epithelial cells of proximal tubules in the renal cortex and inner-medullary collecting ducts. The distribution of immunoreactivity for mature ETs was similar to those of Big ET-1. These observations suggest that mature ET-1 after conversion from Big ET-1 is secreted from these cells. Since similar findings were obtained using anti-Big ET-2 and anti-Big ET-3 antibodies, these two isopeptides are also considered to have certain physiological actions in the kidney. Immunohistochemical studies for ET-A receptor were also performed. The distribution of this receptor was similar to those of Big ETs and mature ETs. This suggests that secreted ET acts on adjacent cells in an autocrine/paracrine manner in the kidney.

[An experimental study of infection stone formation by Corynebacterium species]

The relationship between infection stone and Corynebacterium species was investigated in vitro and in vivo. Urease activity of urease-splitting Corynebacterium species was evaluated by 2 methods; an increase in pH of human urine after inoculation of Corynebacterium species and direct measurement of urease activity of 10(7) CFU organisms from amounts of ammonia by indophenol method. Formation of infection bladder stone was induced in male Wistar rats by implanting a zinc disc and inoculating 10(6) CFU organisms surgically into the bladder. Urine was alkalinized by the inoculation of Corynebacterium renale, C. pilosum and group D2 Corynebacterium. C. renale and C. pilosum had strong urease activity, and group D2 Corynebacterium had moderate activity. C. pseudodiphtheriticum did not produce the elevation of urinary pH and had little urease activity. Infection stones were formed in 100% of rats by inoculation of C. renale and C. pilosum and 88% of rats by group D2. Urinary pH was elevated in all inoculated rats. In conclusion, C. renale, C. pilosum and group D2 Corynebacterium may play a role in formation of infection stones.

[Electron microscopic study on the surface of long-term indwelling silver-protein-coated urethral catheters (Urotopic Ag Protein)]

In order to determine the bacterial and crystal adherence to long-term indwelling urethral catheters, we performed a scanning electron microscopic study utilizing commercially available silver-protein-coated latex (Urotopic Ag Protein) and silicone urethral catheters that were left in place for over 4 weeks. Microorganisms and crystals frequently were associated with fibrillar materials. On the surface of silicone catheters bacteria often were embedded in the amorphous matrix. In contrast we found no bacteria adhering to the antimicrobial urethral catheter surface coated with silver-protein. Crystal formation was similar in both catheters, but no catheteral obstruction was observed in this study. We suggested that antimicrobial urethral catheter coated with silver-protein is applicable to patients who tend to form encrustations on long-term indwelling catheters.

Quality of life survey of urinary diversion patients: comparison of continent urinary diversion versus ileal conduit

BACKGROUND

Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail.

PATIENTS AND METHODS

The questionnaire consisted of 133 questions that covered physical and mental status, social life, sexual habits and symptoms related to urinary diversions. A total of 172 questionnaires were sent out, and 137 (80%) patients (74 CUR and 63 IC patients) responded.

RESULTS

Basic physical conditions were similar in the 2 groups, except for sleeping habits. Regarding social life, however, the CUR group showed better scores in bathing habits and frequency of overnight travel. Parastomal dermatitis was more frequent in the IC group and the patients were more hesitant to show their stoma to others. On the other hand, about half of the patients in the CUR group complained of troublesomeness in self-catheterization, especially at night. Overall, 74% and 41% of the patients in the CUR and IC group were satisfied with their urinary diversion. When the Kock pouch and Indiana pouch were compared, no statistically significant differences were found in average capacity, maximum capacity, or frequency of self-catheterization.

CONCLUSIONS

CUR recipients have enhanced QOL regarding the stoma, travel and sleeping habits as compared to ileal conduit. However, troublesomeness of night time self-catheterization was noted in the CUR group. Individualized selection of the type of urinary diversion with informed consent is essential.

[Clinical analysis of bladder cancer patients treated by radical cystectomy]

We assessed the treatment outcome of 105 patients with transitional cell carcinoma of the bladder treated by total cystectomy at our university hospital, between 1979 and 1993. The patients consisted of 84 men and 21 women (male to female ratio : 4:1), between 45 and 82 years old (mean, 65.5 years old). The overall cancer-specific survival rate at 3 and 5 years was 76.3% and 68.9%, respectively. The 5-year survival rate was 85.2% for grade 2 and 59.9% for grade 3 tumors with a significant difference in the survival curves between the two groups (p < 0.05). The 5-year survival rate according to pathological stage was 100% for pTa, 75.6% for pT1, 78.4% for pT2, 54.0% for pT3 and 39.8% for pT4. A significant difference was observed between pTa and pT3 (p < 0.05), and between pTa-2 and pT4 (p < 0.05). The 5-year survival rate was 72.3% for patients without lymph node involvement and 11.9% for those with lymph node involvement, the difference being significant (p < 0.01). Nineteen patients who received pre- and/or post-operative chemotherapy did not show a higher 5-year survival rate than those who did not.

Assessment of the effects of low dialysate flow rates on removal rates and clearance using high flux membranes

The effects of the low dialysate flow rates on the removal rate and clearance of urea nitrogen, creatinine, uric acid, beta 2-microglobulin and myoglobin, using high flux membranes were studied. The removal rates for all substances were not significantly decreased. Although clearance of urea nitrogen, creatinine and uric acid was significantly decreased (p < 0.05), clearance of inorganic phosphate, beta 2-microglobulin and myoglobin was not significantly decreased. These results suggest that hemodialysis at low dialysate flow rates for a short term during water shortages due to natural disasters and drier climates can be performed with an insignificant reduction in removal rates and a minimum reduction in clearance.

A natural variant of bovine dopamine beta-monooxygenase with phenylalanine as residue 208: purification and characterization of the variant homo- and heterotetramers of (F208)4 and (F208)2(L208)2

Bovine dopamine beta-monooxygenase was purified from each of 18 individual adrenal glands by the method we have developed for the rapid purification of the enzyme from a single adrenal gland. Differential peptide mapping of the 18 enzyme preparations following fluorescence labeling of their cysteine residues revealed the presence of a novel variant with Phe as residue 208 in 14 adrenal glands; seven of them were homozygous for the variant allele and the remaining seven heterozygous. The variant enzyme was a tetramer and exhibited kinetic and structural properties similar to those of the wild-type tetramer (L208)4. These results indicate an allelic polymorphism and codominant expression of the two alleles of the enzyme gene.

Comparison of neurogenic contraction and relaxation in canine corpus cavernosum and penile artery and vein

Functional roles of autonomic efferent nerves were compared in the isolated canine corpus cavernosum, penile artery and penile vein that participate in the penile erection by changing blood distribution. Nicotine produced moderate contraction in the arterial strips, but only a slight or no contraction in the corpus and venous strips. The contraction was suppressed or reversed to a relaxation by prazosin. Under alpha 1-adrenoceptor blockade, relaxations induced by nicotine were in the order of the corpus > artery > > vein. The response was abolished by NG-nitro-L-arginine (L-NA) and restored by L-arginine. The responses to nicotine and exogenous nitric oxide (NO) were abolished by oxyhemoglobin. The relaxant response to transmural electrical stimulation at 5 Hz was greater in the corpus than venous strips treated with prazosin, and it was abolished by L-NA. Contractions caused by nicotine under treatment with L-NA were greater in the artery than in the vein and corpus. Histochemical studies demonstrated nerve fibers containing NO synthase and tyrosine hydroxylase immunoreactivity in the corpus cavernosum, artery and vein. It is concluded that the canine corpus cavernosum, penile artery and penile vein are innervated by adrenergic, vasoconstrictor and nitroxidergic, vasodilator nerves; neurogenic vasodilatation is predominant in the corpus muscle, whereas neurogenic vasoconstriction predominates in the artery. Such a different functioning of the nerves may be responsible for the penile erection.

[Experimental bladder stone production by Ureaplasma urealyticum]

We examined the relationship between struvite stone formation and Ureaplasma urealyticum in male Wister rats by inoculating U. urealyticum and implanting a zinc disc into the bladder surgically. Cultures of U. urealyticum and pH measurements in urine obtained by forced urination were done on days 2 and 6 after operation. Half of the rats were killed 7 days after the operation and the remaining half 14 days after the operation. A total of 46 rats, consisting of 10 rats in the control group and 36 rats inoculated with U. urealyticum, were studied. U. urealyticum was weakly virulent, because it was not detected in the urine culture on day 2 in 10 of the 36 rats inoculated with the organism, and showed a tendency towards spontaneous elimination in the other rats. Urinary pH was elevated slightly by the presence of U. urealyticum. Struvite stones were formed in 52% of the rats by the inoculation on of U. urealyticum, and 69% and 71% of the positive rats in urine culture for U. urealyticum on day 2 and day 6 respectively. The stones tended to be larger the longer U. urealyticum was detected in urine. U. urealyticum may play a role in struvite stone formation, but not a major role.

[Dynamic Gd-DTPA-enhanced MR imaging in evaluation of the function of transplanted kidneys]

The purpose of the study was to evaluate the potential of dynamic Gd-DTPA-enhanced MR imaging in assessing of the function of transplanted kidneys. Dynamic MR imaging was performed using the GRASS pulse sequence in 21 subjects (56 examinations), and in each examination 30 images were obtained after a bolus injection of Gd-DTPA. Imaging findings including signal increase and/or signal drop in cortex, signal drop in medulla, and signal drop in calyces were utilized for the evaluation of renal function. Renal function was also evaluated using the following parameters: Ta, time between the initial observation of signal increase in cortex and signal drop in medulla. Tb, time between the initial observation of signal drop in medulla and in calyces; Tc, Ta + Tb, and Max. C/M, maximum ratio of signal intensity between cortex and medulla among 30 images. In the group of patients with normal graft function (Ccr > or = 60ml/min), all imaging findings were observed. In the group of patients with mild graft dysfunction (30ml/min < or = Ccr < 60ml/min), all imaging findings but signal drop in cortex were observed. The time parameters of Ta, Tb, and Tc were significantly larger, and Max. C/M was significantly smaller than those observed in the group with normal graft function. In the group of patients with severe graft dysfunction (Ccr < 30ml/min), almost none of the findings were observed. The investigation in patients in the postoperative state revealed a close correlation of the imaging findings and the values of parameters with changes in graft function over time. The results indicated the usefulness of the method in semiquantitative evaluation of graft function, including that of patients in postoperative state. This study suggests that dynamic Gd-DTPA-enhanced MR imaging could be a valuable method for the management of transplanted kidneys.

Effect of long-term administration of finasteride (MK-906), an inhibitor of 5 alpha-reductase, in patients with benign prostatic hyperplasia

We evaluated the effect of long-term administration of finasteride (MK-906), a potent inhibitor of 5 alpha-reductase in patients with benign prostatic hyperplasia (BPH). The effect of an increase in dose was also assessed. Finasteride was administered to 61 patients with BPH at the dose of 1 mg/day for 48 weeks. Thirty three of these patients subsequently received finasteride at the dose of 5 mg/day for further 24 weeks in an open extension study. Urinary symptoms, urinary flow rate, residual urinary volume, prostatic volume and serum concentrations of dihydrotestosterone and prostate-specific antigen were examined periodically during the treatment. The size of the prostate and total urinary symptom scores decreased progressively during the first 16 weeks of treatment. The patients who received finasteride had a significant increase in the maximal urinary flow rate and a significant decrease in residual urinary volume. After 72 weeks of treatment, finasteride at an increased dose of 5 mg did not provide additional benefit to patients, although the effects of the drug at a dose of 1 mg were well maintained. Treatment with finasteride was well tolerated at both doses. In conclusion, the treatment of BPH with 1 mg of finasteride per day for 48 weeks results in a significant increase in maximal urinary flow rate, and a decrease in prostatic volume, symptoms of obstruction and residual urinary volume, with minimal toxicity.

Neurogenic nitric oxide mediates relaxation of canine corpus cavernosum

PURPOSE

The aim of the present study is to analyze mechanisms underlying neurogenic relaxation of the corpus cavernosum which are believed to participate in penile erection.

MATERIALS AND METHODS

Mechanical responses to nerve stimulation by electrical pulses and nicotine were measured in strips of canine corpus cavernosum precontracted with phenylephrine. Cyclic guanosine monophosphate (GMP) contents in the strips were also measured by radioimmunoassay. Immunohistochemistry for nitric oxide synthase (NOS) and vasoactive intestinal polypeptide (VIP) was performed.

RESULTS

Transmural electrical stimulation and nicotine produced relaxations in the isolated canine corpus. The neurogenic relaxation was abolished by N omega-nitro-L-arginine, a NOS inhibitor, and the inhibition was reversed by L-arginine. Relaxations induced by nerve stimulation and exogenous nitric oxide (NO) were depressed by oxyhemoglobin and methylene blue. Vasoactive intestinal polypeptide (VIP)-induced relaxations were not influenced by these inhibitors. In the controls strips and those made unresponsive to VIP by its repeated application, the responses to nerve stimulation did not differ. The content of cyclic GMP in the tissue increased in response to nicotine, the effect being abolished by the NO synthase inhibitor. Immunohistochemical study demonstrated neurons containing NOS and VIP.

CONCLUSIONS

It appears that the relaxation induced by nerve stimulation is mediated solely by NO liberated from the nerve that activates soluble guanylate cyclase and increases the production of cyclic GMP in smooth muscle, whereas VIP does not play a role in the regulation of muscle tone under the experimental conditions used.

Long-term followup of patients with tumor thrombi from renal cell carcinoma and total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft

PURPOSE

Inferior vena caval resection and its reconstruction are sometimes necessary when the inferior vena cava is extensively involved by a large and fixed tumor thrombus from renal cell carcinoma or other malignancies. We successfully replaced the inferior vena cava using tubular expanded polytetrafluoroethylene (Teflon) vascular grafts after en bloc removal of the tumor thrombus and inferior vena cava. We followed the patients long term and observed inferior vena caval patency.

MATERIALS AND METHODS

The 3 men and 2 women ranged from 42 to 75 years old. The renal tumors were on the right side in 4 patients and asynchronously bilateral in 1. The suprarenal inferior vena cava was replaced in 3 patients and the infrarenal portion was replaced in 2. The expanded polytetrafluoroethylene tube grafts, 18 to 22 mm. in diameter and 5 to 12 cm. long, were externally stented in 3 patients and not stented in 2.

RESULTS

Followup ranged from 6 to 96 months (mean 58). Long-term patency of the graft was maintained in all patients. Of the patients 3 had no evidence of disease at 6 months and 2 died of recurrent tumor at 6 and 84 months.

CONCLUSIONS

Total replacement of the inferior vena cava using an expanded polytetrafluoroethylene tubular graft may offer a feasible method with good patency rates in the long term.

Shorter interval between cycles of cyclophosphamide, doxorubicin, cisplatin using recombinant human granulocyte colony-stimulating factor for urothelial cancer--phase I/II study

BACKGROUND

Despite improvement in the response rate and protraction of the progression-free period of urothelial cancer produced by chemotherapy, severe bone marrow suppression often results in delays in the initiation of treatment cycles and/or decreases in drug dosages. Reduction of leukopenia during chemotherapy has been demonstrated by the combined administration of granulocyte colony-stimulating factor (G-CSF) in various malignancies.

METHODS

A phase I/II study was conducted to assess whether the interval between cycles of CISCA (cyclophosphamide, doxorubicin, cisplatin) chemotherapy could be shortened under support of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for urothelial cancer. Three or more patients with transitional cell carcinoma of the urinary tract were allocated to each of four different treatment intervals (step 1: 28 days, step 2: 21 days, step 3: 17 days, and step 4: 14 days) by reducing the interval in a step-wise manner. Two mg/kg/day of a rhG-CSF, lenograstim, was injected subcutaneously on days 3 to 16 (until day 14 for the 14-day interval group).

RESULTS

Sixteen patients were enrolled, four patients were treated with the step 1 protocol, five with step 2, four with step 3, and three with step 4. Leukopenia/neutropenia was the most severe toxic reaction, but none of the patients at any step manifested neutropenia of WHO grade 4 for more than four days. There were no significant differences in the hematological and nonhematological toxicities among the 4 steps. Seven of eight patients with measurable diseases were treated with CISCA on shortened schedules (steps 2-4), and one complete remission (CR) and four partial responses (PR) were demonstrated.

CONCLUSIONS

CISCA chemotherapy supported by rhG-CSF was safely shortened to a 14-day interval in the pilot study. The potential role of rhG-CSF in shortening the interval of CISCA, as well as the benefit of the intensified schedule, remains to be clarified.

[A case of urethral diverticulum in a male paraplegic patient]

A case of acquired diverticulum of the male anterior urethra is reported. A 67-year-old man with Pott paralysis caused by tuberculous spondylitis, visited our clinic due to recurrent urinary tract infection. He had used a condom penile sheath to collect urine. Voiding and retrograde cystourethrograms revealed anterior urethral diverticulum. Magnetic resonance imaging (MRI) clearly demonstrated diverticulum and corpus cavernosum penis, but corpus spongiosum penis was not defined. Urethroscopy showed diverticulum in the shape of partially dilated urethra with normal urethral mucosa. After diverticulectomy, self catheterization was endorsed. Histological study of removed diverticulum revealed squamous epithelium and fibrous connective tissue in the wall. The urethral diverticulum of this patient might have arisen from the elevated urethral pressure caused by the condom penile sheath.

Heterogeneity and progression of renal cell carcinomas as revealed by DNA cytofluorometry and the significance of the presence of polyploid cells

With special attention to the presence of polyploid cells, we examined heterogeneity and progression of renal cell carcinomas. We separated 116 blocks from 51 tumors into several specimens according to the histologic findings, and analyzed their DNA ploidy patterns. Thirty-one tumors (61%) were aneuploid, 29 of which showed intratumoral DNA ploidy heterogeneity. Diploid cell lines were observed in 47 tumors (92%). Polyploid cells in the diploid component were more frequently found in tumors with mixed diploid and aneuploid patterns than in the purely diploid tumors. Of the diploid cases, higher stage cases tended to have a higher incidence of polyploid cells than the lower stage cases. The incidence of aneuploid cases and DNA heterogeneity became greater as the tumors progressed. Aneuploid cases had a poorer outcome than did the diploid cases. If diploid cases with polyploid cells were classified as aneuploid cases, the difference in the survival rate between the diploid and aneuploid cases became more significant. Diploid renal cell carcinomas with polyploid cells may be an intermediate stage between diploidy and aneuploidy. Analyzing renal cell carcinomas for the presence of polyploid cells is useful for differentiating diploidy, which is actually aneuploid, from pure diploidy.

[Postoperative complications of self-catheterizable continent urinary diversions (Kock, Indiana, and appendiceal Mainz pouch) and patient care]

A self-catheterizable continent urinary reservoir has become one of the major options for urinary diversion in patients with invasive bladder cancer or other pelvic malignancies. We performed the Kock pouch, the Indiana pouch and the appendiceal Mainz pouch in 124, 51 and 4 patients with the mean followup periods of 50, 33, and 10 months, respectively. In the Kock pouch, the efferent and afferent nipple valve malfunction was seen in 16.7 and 21.3 percent each, requiring repair surgery, such as fixation of the efferent nipple to the pouch wall, reconstruction of an isoperistaltic nipple valve in the former, and removal of the Dacron fabric collar or re-anastomosis of the ureter to the pouch using LeDuc technique in the latter. In the Indiana pouch, stomal stenosis, an hourglass-like pouch deformity, difficult catheterization occurred in 3, 2 and 2 patients, respectively. Among the 4 patients with the appendiceal Mainz pouch, there were no major late postoperative complications except for mild stenosis of the conduit, handled with bougienage. As a whole, surgical revisions, related to urinary diversion, was done in 20.3, 10.6, 0 percent in the Kock, Indiana, Mainz pouch patients, respectively. Stone formation, mostly multiple and recurrent, occurred in 27.8, 6.4, 0 percent in the Kock, Indiana, Mainz pouch, respectively. Most of the stones were removed endoscopically via a stoma or by percutaneous approach. Acidosis was seen in 3 patients in both the Kock and Indiana pouch, and 3 patients with the Kock pouch suffered from symptomatic choleithiasis. At the time of the latest observation, continence was achieved in 90.2, 93.0, and 100 percent, whereas excretory urograms showed normal collecting systems in 64.5, 90.4, and 100 percent in the Kock, Indiana, and Mainz pouch, respectively. In conclusion, the Kock pouch, performed by an original method using unabsorbable polyester fabric collars and metallic staples, has an intolerably high rate of late complications, and either the modified Indiana pouch with ileal patch or the appendiceal Mainz pouch using the umbilicus as a stoma is recommended for a self-catheterization continent urinary diversion.

[Malacoplakia of the prostate: report of a case]

We report a case of prostatic malacoplakia clinically diagnosed as prostatic cancer. A 65-year-old man was seen with increased urinary frequency, and urinalysis disclosed moderate pyuria. After the administration of antibiotics for several days, the urine was sterile and the symptoms disappeared, but findings of digital examination of the prostate were compatible with prostatic cancer. Transperineal needle biopsy of the prostate was reported as poorly differentiated adenocarcinoma on the piece from the left lobe. Following further evaluation, the patient underwent radical prostatectomy under the preoperative diagnosis of stage B1 prostatic cancer. However, histological diagnosis of the surgical specimen was malacoplakia of the prostate.

[Retroperitoneal myxoid leiomyoma: report of a case]

We report a case of retroperitoneal myxoid leiomyoma in a 36-year-old woman complaining of urinary retention. An ultrasonogram revealed a mass in the pelvic space, while CT and MRI demonstrated a retroperitoneal tumor. Open resection of the tumor was performed. The resected tumor weighed 600 g and measured 16 x 11 x 9 cm. Histological examination disclosed a tumor mainly composed of smooth muscle with myxomatous change and only rare mitoses. The pathologic diagnosis was retroperitoneal myxoid leiomyoma. Twenty-seven cases of this type of lesion previously reported in the Japanese literature were reviewed.

Acetylcholinesterase-positive afferent axons in mucosa of urinary bladder of adult cats: retrograde tracing and degeneration studies

Acetylcholinesterase (AchE)-positive afferent axons in the mucosa of the cat urinary bladder were examined in the present experiments. Small-sized dorsal root ganglion cells containing AchE enzyme activity were labelled by injection of retrograde tracer (wheat germ agglutinin conjugated to enzymatically inactive horseradish peroxidase gold complex) into the bladder mucosa of adult cats. Results show that 48.9% (90/184) of the labelled ganglion cells possessed AchE enzyme activity. Following unilateral dorsal root ganglionectomy (L2-5, S1-3), a total of 6619 unmyelinated axon terminals were examined in the bladder mucosa, including 691 degenerating axon terminals. Percentages (8.;6-16.1%) of degenerating axon terminals in the ganglionectomized animals (1, 2, 3, 10 and 21 days post-operated) were significantly higher than those of controls (3.1%) and the 60-day post-operated animals (3.2%). Approximately one-half (47.9%) of the degenerating axon terminals observed in the 1-21 day post-operated animals were AchE-positive. Further examination also disclosed that the population of the intact (not affected by ganglionectomy) AchE-positive axon terminals at 60 days (59.3%) was significantly greater than that of controls (45.6%). The AchE-positive terminals containing few synaptic vesicles were significantly increased in number in the 60 day post-operated cats. In conclusion the present study demonstrates that one half of afferent axons in the mucosa were AchE-positive. The increase in AchE-positive afferent axon terminals containing few synaptic vesicles may be derived from contralateral dorsal root ganglia resulting from sprouting following dorsal root ganglionectomy.

Immunohistochemical study of HNK-1 (Leu-7) antigen in prostate cancer and its clinical significance

Anti-HNK-1 monoclonal antibody (MAb) was reactive with non-cancerous and cancerous prostatic epithelia, as well as natural killer cells, myelinated nerves and cells from APUD systems. The expression of HNK-1 antigen on prostate cancer was investigated immunohistochemically by avidinbiotin-peroxidase complex (ABC) method with anti-HNK-1 MAb to clarify the relationship between anti-HNK-1 immunostaining of the cancerous tissue and the tumor differentiation, and that between the former and the survival rate of patients. Of 52 patients with prostate cancer, 49 were reactive with anti-HNK-1 MAb, the positive rate being 94%. The well differentiated cancer showed the highest percentage of positive cancer cells and the strongest staining, while the poorly differentiated cancer had the lowest percentage of positive cancer cells and the weakest staining. HNK-1 antigen was highly expressed on prostate cancer, and the better differentiated the cancer, the more HNK-1 antigen expressed. We also analyzed the total 5-year survival rate of the 52 patients, and the average 5-year survival rate and non-progression rate of 32 patients in stage D2 who had received only endocrinotherapy. Significantly higher survival rate and non-progression rate were observed in the group with more than two-thirds positive cancer cells as compared with the group with less than two-thirds positive cancer cells. The results suggest that the expression of HNK-1 antigen on prostate cancer may be a useful prognostic factor for patients with prostate cancer.

Low-affinity nerve growth factor receptor immunoreactivity in the human urinary bladder

The localization of low-affinity nerve growth factor receptor (LNGFR) in the human urinary bladder was examined immunohistochemically using the mouse monoclonal antibody (ME20-4) against human LNGFR. LNGFR immunoreactivity was present in the human urinary bladder. The distribution of LNGFR-positive fibers was more abundant in the mucosa than in the muscle layer. Results also showed that some LNGFR-positive fiber bundles contained tyrosine hydroxylase immunoreactivity. Electron microscopic examination revealed that LNGFR immunoreactivity was located on the surface of Schwann cells, and frequently on the interface of axons and Schwann cells.

Variable-region sequences for T-cell receptor-gamma and -delta chains of rabbit killer cell lines against Shope carcinoma cells

A rabbit gamma delta killer T-cell line against Shope carcinoma cells was established from peripheral blood lymphocytes (PBL) of a human T-lymphotropic virus type I (HTLV-I)-infected rabbit bearing Shope papilloma and carcinoma. Southern hybridization analysis of this cell line with an HTLV-I probe showed that the cell line contained multiple clones of HTLV-I-transformed cells, and three sublines with different integration patterns of the HTLV-1 genome were isolated by cloning of the cell line. In all these sublines T-cell receptor (TCR)-gamma and -delta genes were rearranged and expressed. A PCR-based analysis of the expression of variable (V) genes showed that the killer cell line preferentially expressed V gamma 1.1 and V delta 1 genes, whereas V gamma 2 and V delta 1 genes were dominantly expressed in normal PBL. Analysis of the junctional sequences of TCR-gamma and -delta genes which dictate the fine specificities of epitope recognition revealed that all three sublines expressed V gamma 1.1/V delta 1 genes without the nucleotide diversity at the V-J junctions.

[Spontaneous renal rupture caused by renal pelvic tumor: a case report]

A case of spontaneous rupture of the right kidney caused by a primary renal pelvic tumor is reported. A 57-year-old man complaining of right flank pain and gross hematuria was referred to our hospital in November 1992. In 1982, transurethral resection of the bladder tumor (TUR-Bt) and vesical instillation with mitomycin-C (MMC) had been performed at another hospital for recurrent bladder tumor. In 1988, the excretory urogram showed right hydronephrosis in the absence of a bladder tumor. In 1992, the excretory urogram revealed nonvisualization of the right kidney and obscurity of the right psoas muscle shadow. On the retrograde pyelogram, the upper calyx was irregular and the middle and lower calices were not clearly visualized. Selective renal arteriography demonstrated loss of continuity between the middle portion and lower poles. Right nephroureterectomy with bladder cuff was performed. The severely dilated pelvis contained a large amount of coagula and a papillary tumor. The thin renal parenchyme was lacerated at the lower pole. Histopathological findings revealed noninvasive transitional cell carcinoma. The present case represents the 6th spontaneous renal rupture caused by a renal pelvic tumor reported in Japan.

Relationship between apparent total body clearance of cyclosporin A and its erythrocyte-to-plasma distribution ratio in renal transplant patients

To establish an optimal method for determining a cyclosporin A (CyA) regimen based on physiological changes that occur during immunosuppressive therapy, the relationship between apparent CyA body clearance (CL/f) and the CyA erythrocyte-to-plasma distribution ratio (CyA-EP) was examined using clinical time courses obtained during routine monitoring. The CyA-EP, which was calculated by a multiple regression formula using routine data, was increased during renal dysfunction involving the normal recovery phase after transplantation, during nephrotoxicity, during acute tubular necrosis, and during acute renal rejection. CyA total body clearance (CLt), calculated by multiplying CL/f and converted bioavailability, fc (which is equal to 0.009 x LD, where LD represents the CyA level in blood per dose ratio), showed hyperbolic decay with increasing CyA-EP (the mean CLt was defined as follows: CLt = 0.937/CyA-EP), whereas fc showed exponential decay with increasing CyA-EP (the mean fc was defined as follows: fc = 0.593 x exp(-0.155 x CyA-EP)). These findings suggest that total CyA body clearance and its bioavailability were suppressed during the renal dysfunction phase. Hence, the mean CL/f as a function of the CyA-EP was given by the following equation: CL/f = 1.390 x exp(0.204 x CyA-EP)/CyA-EP. Since the CyA-EP reflects a patient's disease state and alterations in the CyA pharmacokinetic profile, these model formulae should provide an adequate method for determining a CyA dosage regimen for several disease states after renal transplantation.

Varied expression of major histocompatibility complex and oncogenes in Shope carcinoma cell lines derived from a single tumor

The cellular gene expression was compared in four Shope carcinoma cell lines, which were derived from a single tumor and possess various potentials for differentiation and tumorigenicity. The E6 and E7 transforming genes of cottontail rabbit papillomavirus were expressed in all these cell lines, highest level of expression being in the most tumorigenic and undifferentiated cell line, where the major histocompatibility complex (MHC) class I expression was the lowest. The MHC class II antigen, which is not expressed on normal epithelial cells, was detected in all the cell lines, but hardly, if at all, on the surface of these cells. The surface expression of the MHC class II antigen could not be induced by the culture supernatant of phytohaemagglutinin-stimulated splenocytes, which increased the surface expression level of the MHC class I antigen of the same cells. These findings suggest that the aberrant expression of the MHC class II antigen in these cells could not be implicated in the immune response against tumors. The c-fos, c-myc and c-H-ras oncogenes were variably expressed in these cell lines, but there was no correlation with tumorigenicity.

[Fibroma of the bladder associated with a large diverticulum: a case report]

A 57-year-old woman was admitted with a chief complaint of difficult urination on June 7, 1993. A filling defect and a large diverticulum were revealed on the cystogram. Cystoscopy showed a tumor, obstructing the internal urethral orifice at the bladder neck and a diverticulum at the right posterior wall of the bladder. Under the preoperative diagnosis of a benign bladder tumor with a diverticulum, resection of the tumor and transvesical diverticulectomy were performed by a suprapubic approach. The resected tumor was smooth-surfaced, elastic soft and was measured 2.0 by 1.5 by 1.0 cm in size. Histologically, the tumor was diagnosed as a benign fibroma of the urinary bladder. The postoperative course was uneventful. Non-epithelial benign bladder tumors are rare. To our knowledge, this is the 18th case of bladder fibroma in the Japanese literature. The characteristics of bladder fibroma are briefly described.

Adrenergic innervation of the urinary bladder body in the cat with special reference to structure of the detrusor muscle: an immunohistochemical study of noradrenaline and its synthesizing enzymes

The distribution of adrenergic nerves in the body detrusor muscle of the cat urinary bladder was studied by means of the immunohistochemical identification of noradrenaline (NA) and the NA synthesizing enzymes tyrosine hydroxylase, aromatic L-aminoacid decarboxylase and dopamine beta-hydroxylase. We identified the basic structural organization of the detrusor muscle, which had previously been described as lacking discernible layers. In the lateral wall, both outer longitudinal and inner circular muscle bundles were present, the latter extending in both anterior and posterior directions. The posteriorly running bundles came to lie on the outside of the posterior wall where they enabled recognition of inner longitudinal muscle bundles. Those running anteriorly were dispersed to enter the longitudinal bundles in the anterior wall. NA-immunoreactive nerve fibers in the detrusor muscle of the bladder were found to be similar to those immunoreactive for NA synthesizing enzymes in both distribution and density. In the upper and middle bladder body--including the dome (apex)--immunoreactive nerve fibers were always more abundant in the outer part of the detrusor muscle than in the inner part, regardless of the course of muscle bundles. Even in individual muscle bundles running from the inside to the outer surface, the outer part was more richly innervated by immunoreactive fibers than the inner part. In the bladder dome, a moderate number of immunoreactive nerve fibers preferentially innervated the outer part of the muscle layer. In the lower bladder body, these nerve fibers increased in density in the inner part of the detrusor muscle. There was no sexual difference in density or distribution of nerve fibers. NA- and NA synthesizing enzyme-immunoreactive nerve fibers were markedly decreased in number after 6-hydroxydopamine treatment. No dopamine- or phenylethanolamine-N-methyltransferase-immunoreactive nerve fibers were present in the bladder. The findings of this study indicate that the cat bladder musculature includes longitudinal and circular muscle bundles, both of which are extensively innervated by adrenergic nerves, particularly in the outer part of the bladder.

Morphological analysis of ileal grafting following ileocystoplasty in the rat: a kinetic and ultrastructural study of the intestinal epithelium

Ileocystoplasty was performed in rats and the morphological and cell-kinetic changes occurring in the ileal grafts were determined at intervals up to 18 months postoperatively. The intestinal mucosa underwent no progressive changes but included villous and avillous regions associated with crypts of various sizes at all time intervals. Newly appearing and densely packed epithelial cells, shaped like petals, were always present in the lower parts of the villi associated with crypts showing no elongation, but seldom present in those with elongated crypts in the villous mucosa. Bromodeoxyuridine studies showed that the petal-shaped cells interfered with cell migration. No petal-shaped cells were observed in avillous mucosa in which the rate of cell turnover depended on crypt size. Fine-structural changes in absorptive epithelial cells in both types of mucosa included features of prematurity or hypermaturity in the cytoplasm and close adherence to the basal portions of adjacent cells and to the basal lamina. These changes may possibly contribute to the prevention of reabsorption of urine. However, some of the mechanisms responsible for adherence of the basal parts might incidentally interfere with the normal cell kinetics of the intestinal epithelium, resulting in dense packing of cells and the formation of multiple types of mucosa in ileal grafts.

A simple method for predicting the cyclosporin A erythrocyte-to-plasma distribution ratio in blood, and its clinical assessment

To adapt the monitoring of cyclosporin A (CyA) to clinical practice, we have developed a model to predict the CyA erythrocyte-to-plasma distribution ratio (CyA-EP), and evaluated its utility in clinical practice. We monitored CyA trough concentrations in whole blood and performed a series of biochemical tests during disease states in patients undergoing immunosuppressive therapy with CyA after transplantation. An estimate of CyA-EP (EPpr) was thus given by the following equation: EPpr = 6.0831 - 0.2944 x (TG+CHO) - 0.0037 x (CyAblood) - 0.0553 x (HCT) + 0.0463 x (BW) + 0.4447 x (CRE) - 0.0366 x (AGE). In this predictive model, EPpr is given as a function of the plasma lipid levels (TG+CHO, mM), the CyA concentration in whole blood (CyAblood, ng/ml), and the hematocrit (HCT, %), as well as the patient's body weight (BW, kg), serum creatinine (CRE, mg/dl) and age (AGE, years). The parameters TG+CHO, CyAblood, HCT, and AGE were negatively correlated with the CyA-EP, whereas BW and CRE exhibited a positive correlation. The predictive performance of this model was satisfactory for clinical use and changes in CyA-EP in transplant patients were obtained from monitoring CyA in whole blood and routine biochemical tests, without directly measuring CyA-EP. Since CyA-EP is an useful indicator for predicting a shift of CyA into tissues and its systemic clearance in plasma, our model to predict the CyA-EP will help the physician select a CyA regimen during immunosuppressive therapy in a variety of disease states after transplantation.