ISSN:0042-1138    

DOI:10.1159/000283065

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Nucleation, growth and aggregation are thought to be the most important crystallization processes in stone formation. Since crystallization properties change with urinary dilution, centrifugation and filtration, crystallization should always be studied in freshly voided and not pretreated urine. Recently we developed an automated method where calcium oxalate crystallization is induced in native urine by an exogenous oxalate load and nucleation and growth are monitored by an ion-selective calcium electrode. The method has now been supplemented with the spectrophotometric measurement of crystal aggregation. Repeated experiments in the same urine with different oxalate loads enable the determination of the critical oxalate additionable to induce crystallization (metastable limit) and the calculation of an oxalate load-independent growth rate constant. Preliminary results obtained in the native urine of healthy controls showed an extremely high limit of metastability and a complete absence of crystal aggregation. These findings may explain why, despite frequent urinary calcium oxalate supersaturation, healthy people do not form stones.

ISSN:0042-1138    

DOI:10.1159/000283066

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Tachykinins act as stimulants of the isolated urinary bladder. However, the efferent role of tachykinins on detrusor function is controversial. We investigated the contractility of isolated human neurogenic bladders taken from patients with myelomeningocele or sacral agenesis, and tested the response to neurokinin A (NKA), neuromedin K (NKB), and substance P (SP). The contractile strengths were compared with normal controls. All tachykinins investigated induced significant contractions in both neurogenic and control bladders. The rank order of contractile potency was the same in both groups, namely, NKA > NKB > SP. The contraction induced by SP was not affected by atropine, but was completely blocked by [Sar9, Met(O2)11]-SP (a SP antagonist). Responses to electrical field stimulation were not changed by the SP antagonist. The contractile magnitude to field stimulation was also not altered by administration of 10––6M tachykinins. Responses of the neurogenic bladder to NKA and SP were significantly greater than the control. There were no differences in the response to KCl administration between the 2 groups. We conclude that hypersensitivity to NKA and SP in neurogenic bladders may contribute to bladder dysfunction in patients with sacral cord lesi

ISSN:0042-1138    

DOI:10.1159/000283067

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Detrusor dysfunction secondary to partial outflow obstruction is caused in part by decreased blood flow to the detrusor. We investigated changes in blood flow to the bladder and in bladder function after inducing partial outflow obstruction. The urethras of male Sprague-Dawley rats were constricted by sutures to degrees representing either mild and severe obstruction. Blood flow to the bladder was measured by a Doppler flowmeter prior to and 7 days after obstruction. In vivo and in vitro experiments were performed 7 days after surgery. After cystometry was used to determine bladder capacity, the pressure at which micturition was induced, and maximum voiding pressure, the bladder was removed and placed in an organ bath where increases in intravesical pressure in response to field stimulation were evaluated. Finally, volume-pressure studies were performed in order to determine passive detrusor compliance and response to field stimulation at each specific capacity in vitro. Although blood flow to the bladder was significantly decreased by severe obstruction, no differences in blood flow between control and mildly obstructed bladders was observed. While maximum voiding pressure decreased in severely obstructed bladders, both the pressure at which micturition was induced and bladder capacity were increased. The response to field stimulation was increased by mild obstruction but decreased by severe obstruction, although bladder compliance was increased by both. The peak response to filled stimulation was observed at a larger capacity in severely obstructed bladders than the others. In conclusion, when outflow obstruction was mild, blood flow to the bladder remained unchanged and detrusor contractility increased. On the other hand, severe obstruction decreased bladder blood flow and induced deterioration of detrusor function.

ISSN:0042-1138    

DOI:10.1159/000283068

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Objective: Current reports suggest the presence of androgen receptor (AR) defects in prostate cancer. We have detected the AR mRNA in normal, benign hypertrophied (BPH) and carcinomatous (CaP) prostate tissues and evaluated the difference in the level of AR transcript in these groups. Materials and Methods: Cytoplasmic dot hybridization assay was used to measure the levels of AR mRNA in 21 normal, 45 BPH and 30 CaP specimens. Tissue samples of 14 CaP patients receiving endocrine treatment were also analyzed. Blots were autoradiographed and the intensity of the signal was measured by densitometry. Results and Conclusions: The majority of cases in all the 3 groups were positive for the AR mRNA. All the patients who had received endocrine treatment were also positive for the AR mRNA. The level of the AR mRNA was significantly higher in BPH and treated CaP cases as compared to normal cases (p < 0.05). Among the CaP cases the level of AR transcript was significantly higher in the treated group as compared to the untreated group.

ISSN:0042-1138    

DOI:10.1159/000283069

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Objectives: Prostate-specific antigen (PSA) is no longer believed to be tissue specific for prostate epithelial cells as it has been documented in various human tissues. The physiological role of PSA in this context is currently unknown. Furthermore the distribution of PSA throughout the human body remains to be established. We therefore investigated PSA immunoreactivity in human spinal fluid (SF). Methods: The PSA concentration was measured in the SF and sera of 34 men and 6 women. The SF was obtained prior to spinal anesthesia and was kept frozen at ––20°C until analysis. Results: PSA was detected in the SF of male patients. Median SF PSA was 0.03 ng/ml in the 34 men, whereas SF PSA was below the detection limit in the 6 women. In men we could establish a positive correlation between SF PSA and serum PSA with a correlation coefficient of r = 0.85 (p < 0.001). Conclusion: These results confirm recent literature reports indicating that PSA is detectable in various human tissues and fl

ISSN:0042-1138    

DOI:10.1159/000283070

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Objective: Systematic sextant biopsies are a powerful tool in the diagnosis of prostate cancer. Interpretation of the histopathologic results of these biopsies plays a central role in treatment decisions. This biopsy approach was originally described as sampling the prostate in the mid-lobe, parasagittal plane at the apex, mid-gland, and base, bilaterally. Morphometric analysis of prostate specimens has revealed that most clinically significant cancers are mainly located in the posterolateral aspect of the gland, not the mid-lobe. We sought to determine if cancer detection could be improved by obtaining more laterally placed biopsies. Materials and Methods: Forty-one patients underwent transrectal ultrasound with mid-lobe sextant as well as lateral sextant biopsies. Biopsy specimens were evaluated for Gleason grade and length of cancer present in each core. The mid-lobe and lateral biopsy results were then compared. Results: Thirteen of 41 patients (31.7%) were found to have no cancer on either biopsy set. Cancer was detected by both the mid-lobe and the lateral biopsies in 19 patients (46.3%). In 6 patients (14.6%), only the lateral biopsies revealed cancer, and in 3 patients (7.3%), only the mid-lobe biopsies revealed cancer. Conclusions: Laterally-placed systematic sextant biopsies may yield an improved diagnosis rate in patients with palpable nodularity in the lateral aspect of the prostate, patients without any palpable abnormalities but with elevated PSA levels, and in those patients undergoing repeat biopsies.

ISSN:0042-1138    

DOI:10.1159/000283071

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The relative risk for a second primary cancer after the diagnosis of prostate cancer and the prognostic impact of the association of multiple primary malignant neoplasms (MPMNs) in patients with prostate cancer were analyzed in a retrospective study. The development of MPMNs was examined in 312 consecutive patients who had been diagnosed with prostate cancer between 1966 and 1992. The population-based cancer incidence rates in Japan were utilized to calculate the expected number of MPMNs. Of the 312 patients, 60 fulfilled the diagnosis of MPMNs. In 13 men, prostate cancer and other malignancies were diagnosed simultaneously. In 35 of the 312 patients, prostate cancer was the second or third cancer diagnosis. In the remaining 287 patients, prostate cancer developed initially. Of the 287 patients, 12 developed a second primary malignancy compared with 17 expected (relative risk 0.71, 95% confidence interval 0.45–1.4). No single anatomic site showed a significantly increased risk above that expected either. The overall survival of patients with prostate cancer was not reduced by the association with MPMNs. This may be explained by the fact that the stage of the prostate cancer was lower in patients with MPMNs than in patients without MPMN

ISSN:0042-1138    

DOI:10.1159/000283072

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Objectives: To date, chemotherapy for advanced urothelial carcinoma has been associated with only moderate therapeutic success and minimal extension of survival. This, coupled with the occurrence of serious side effects and the resulting reduced quality of life, underscores the need for new chemothera-peutic agents. A first study investigating combination therapy with etoposide and ifosfamide reported not only comparable therapeutic effectiveness but, due primarily to the elimination of the cisplatin component, a reduction in nephrotoxic side effects. In the present study, therefore, patients with advanced urothelial carcinoma and minor compromised renal function received combination chemotherapy with etoposide and ifosfamide. Methods: Fourteen patients with advanced urothelial carcinoma underwent chemotherapy with a combination of etoposide and ifosfamide. On days 1–5, patients received 1,500 mg/m2 ifosfamide and 120 mg/m2 etoposide. The next corresponding cycle was started on day 22. Results: A number of serious side effects were observed. These consisted predominantly of high-grade myelo-suppression requiring therapy, as well as disturbances in the central nervous system and impairment of renal function. Due to severe side effects, chemotherapy had to be prematurely terminated in 8 of 14 patients (57%). The efficacy of therapy, however, was observed in patients completing the treatment regimen. Conclusions: The new combined chemotherapy with etoposide and ifosfamide shows efficacy in the treatment of advanced urothelial carcinoma. This, however, is overshadowed by the high rate of serious side effects leading to premature interruption of therap

ISSN:0042-1138    

DOI:10.1159/000283073

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Fungal urinary tract infections are increasingly prevalent in hospitalized patients. This trial compares the efficacy of oral fluconazole along with catheter replacement to that of catheter replacement alone for treatment of funguria. The study group patients (n = 30) were given 100 mg of fluconazole followed by 50 mg/day for 14 days and had their catheters replaced on day one. The control group, randomized on a 1:1 basis (n = 30) had only a catheter replacement. Seventeen and 21 patients in the study and control groups, respectively, had Candida albicans, 8 and 5 had Candida tropicalis, and 5 and 4 had Candida glabrata. The MICs of the organisms were determined by the E test. The MIC90 of the C albicans, C tropicalis, and C. glabrata were 12,16, and 64 µg/ml, respectively. Funguria disappeared in all study group patients within a week but recurred in only 1 patient 8 weeks after enrollment in the study. Although fluconazole caused a more rapid and an almost complete eradication of funguria and urinary WBCs, catheter replacement alone was followed by an 87–93% clearance of urinary findings at 8 weeks of follow-up. These results suggest that in patients with funguria low-dose fluconazole induces a more rapid clearance of urinary findings than does catheter replacement alo

ISSN:0042-1138    

DOI:10.1159/000283074

出版商:S. Karger AG    

年代:1997

数据来源: Karger