Thumb boutonnière deformity without rheumatoid arthritis or trauma.

Boutonnière deformity of the thumb without rheumatoid arthritis or trauma is not widely recognised. This study aimed to investigate its prevalence, relation to sex and age, and identifying factors associated with the extensor mechanism using ultrasonography. We examined 248 thumbs from 127 participants who were asymptomatic for hand disorders and had no history of hand injury. Boutonnière deformity was identified in 20 thumbs of 17 participants and was significantly more prevalent among elderly participants than among young participants. No significant differences in sex or hand dominance were noted. The deformity had a significant effect on range of motion and grip and pinch strengths. The extensor pollicis brevis (EPB) tendon was significantly narrower in affected thumbs than in non-affected thumbs. The prevalence of boutonnière deformity without rheumatoid arthritis or trauma was 13%, and the deformity was associated with advanced age and a narrow EPB tendon. LEVEL OF EVIDENCE: III.

Activation of the Wnt/ß-catenin signaling cascade after traumatic nerve injury.

Recent data have shown that preservation of the neuromuscular junction (NMJ) after traumatic nerve injury helps to improve functional recovery with surgical repair via matrix metalloproteinase-3 (MMP3) blockade. As such, we sought to explore additional pathways that may augment this response. Wnt3a has been shown to inhibit acetylcholine receptor (AChR) clustering via ß-catenin-dependent signaling in the development of the NMJ. Therefore, we hypothesized that Wnt3a and ß-catenin are associated with NMJ destabilization following traumatic denervation. A critical size nerve defect was created by excising a 10-mm segment of the sciatic nerve in mice. Denervated muscles were then harvested at multiple time points for immunofluorescence staining, quantitative real-time PCR, and western blot analysis for Wnt3a and ß-catenin levels. Moreover, a novel Wnt/ß-catenin transgenic reporter mouse line was utilized to support our hypothesis of Wnt activation after traumatic nerve injury. The expression of Wnt3a mRNA was significantly increased by 2 weeks post-injury and remained upregulated for 2 months. Additionally, ß-catenin was activated at 2 months post-injury relative to controls. Correspondingly, immunohistochemical analysis of denervated transgenic mouse line TCF/Lef:H2B-GFP muscles demonstrated that the number of GFP-positive cells was increased at the motor endplate band. These collective data support that post-synaptic AChRs destabilize after denervation by a process that involves the Wnt/ß-catenin pathway. As such, this pathway serves as a potential therapeutic target to prevent the motor endplate degeneration that occurs following traumatic nerve injury.

Development and validation of an illustrated questionnaire to evaluate disabilities of the upper limb.

We have developed an illustrated questionnaire, the Hand20, comprising 20 short and easy-to-understand questions to assess disorders of the upper limb. We have examined the usefulness of this questionnaire by comparing reliability, validity, responsiveness and the level of missing data with those of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. A series of 431 patients with disorders of the upper limb completed the Hand20 and the Japanese version of the DASH (DASH-JSSH) questionnaire. The norms for Hand20 scores were determined in another cross-sectional study. Most patients had no difficulty in completing the Hand20 questionnaire, whereas the DASH-JSSH had a significantly higher rate of missing data. The standard score for the Hand20 was smaller than the reported norms for the DASH. Our study showed that the Hand20 questionnaire provided validation comparable with that of the DASH-JSSH. Explanatory illustrations and short questions which were easy-to-understand led to better rates of response and fewer missing data, even in elderly individuals with cognitive deterioration.

Co-expression of hepatocyte growth factor and its receptor in human prostate cancer.

Hepatocyte growth factor acts differently depending on the organs or tumours involved. It may be produced simultaneously with its receptor, c-Met, in several types of malignant tumour cells and may exercise an autocrine regulation. To analyse the effect of hepatocyte growth factor in human prostate cancer, we conducted immunohistochemistry, in situ hybridization and the reverse transcriptase polymerase chain reaction. The first two techniques revealed the growth factor in prostate cancer cells, and the polymerase chain reaction confirmed this expression. c-Met is expressed in prostate cancer cells, but not in interstitial cells. Hepatocyte growth factor is expressed in interstitial cells, especially in hormone-treated cancer tissue, indicating that the growth factor pathway changes with the hormonal status. Low-grade tumours expressed c-Met at the plasma membrane. Higher grade tumours tended to express it in the cytoplasm, suggesting that the role of c-Met as the hepatocyte growth factor receptor was blocked in higher grade tumours. The relationship between the growth factor and its receptor is thus influenced by hormonal status and differentiation in prostate cancer and is not explained simply in terms of autocrine or paracrine action.

Evaluation of histological structure and its effect on the distribution of alpha1-adrenoceptors in human benign prostatic hyperplasia.

OBJECTIVE: To evaluate the histological structure of benign prostatic hyperplasia (BPH) and its relationship with the density of alpha1-adrenoceptors in smooth muscle. MATERIALS AND METHODS: Specimens from hyperplastic tissues obtained from 14 patients with BPH were evaluated for the density of alpha1-adrenoceptors in smooth muscle using autoradiography, Mallory-Azan staining and computer-assisted image analyses. The binding of [3H] tamsulosin (a selective alpha1-blocker) and the ratio of smooth muscle area was calculated, and the density of alpha1-adrenoceptors per area of smooth muscle determined by dividing the degree of binding by the ratio of smooth muscle to total area. RESULTS: There was a significant difference between the ratio of smooth muscle area in the hyperplastic acinar nodule and the surrounding stroma (P < 0.01). The density of alpha1-adrenoceptor per smooth muscle area was significantly higher in the hyperplastic acinar nodule than in the surrounding stroma (P < 0.05). There was no correlation between prostatic weight and the ratio of smooth muscle area or the density of alpha1-adrenoceptors in each region. CONCLUSION: The distribution of alpha1-adrenoceptors on smooth muscle differed with histological structure; both the histological conformation and the difference in the distribution of alpha1-adrenoceptors could affect urethral obstruction in BPH.

[A case of hormone-refractory prostate cancer responsive to low-dose prednisolone therapy].

A 67-year-old man with hormone-refractory (stage D2) prostate cancer was admitted to the hospital because of general malaise and bone pain. The patient had been receiving hormonal therapy, which was discontinued after admission. Instead, 10 mg per day of prednisolone was administered orally. His symptoms improved, and the serum prostate specific antigen (PSA) level decreased markedly. After 18 weeks of treatment with prednisolone, the serum PSA level rose again, and bone pain worsened. The patient died of cancer one month later.

Immunohistochemical expression of glucose transporter-1 in human penile proliferative lesions.

Glucose transporters (GLUTs) are a family of membrane proteins responsible for the transport of glucose across cellular membranes. In terms of their mRNA levels, they have been reported to be expressed in some human tumours. However, the immunohistochemical localization of GLUTs in human urogenital lesions has rarely been studied. This study was performed to evaluate the expression of GLUT1 in penile proliferative lesions (18 cases of penile carcinoma and 13 cases of condyloma acuminatum). Using an isoform-specific anti-GLUT1 antibody, formalin-fixed paraffin-embedded sections were stained by the avidin-biotin complex method. In all cases of penile carcinoma, GLUT1 staining was diffusely recognized on the cell membrane of the carcinoma cells in the mainly infiltrating areas. However, the inner areas of the tumour were more weakly and focally stained. The intensity of staining for the penile carcinoma (staining score = 2.8 +/- 0.6) was stronger than that for condyloma acuminatum and that for adjacent non-proliferative areas. All cases of condyloma acuminatum showed a diffuse staining on the cell membrane in the basal and intermediate layers (staining score = 2.4 +/- 0.5). Non-proliferative (histologically normal) glans areas adjacent to the above lesions expressed the weakest GLUT1 staining only in the stratum basale (staining score = 1.8 +/- 0.5). These three areas showed significantly different staining scores from each other (p < 0.01). In conclusion, GLUT1 is expressed dominantly in penile proliferative lesions, especially in infiltrating areas of penile carcinoma.

Decreased contractile effect of endothelin-1 on hyperplastic prostate.

1. The contractile activity, binding activity and localization of endothelin (ET)-1 were evaluated in human nonhyperplastic (control) and hyperplastic prostates. 2. ET-1 caused contraction of both prostates in a dose-dependent manner. However, this contraction was markedly decreased in hyperplastic prostates. 3. Bmax and Kd values of hyperplastic prostates were greater than those of the control. 4. The muscle and proliferative epithelium of hyperplastic prostates showed strong staining for the anti-ET-1 antibody. However, the glandular epithelium of control prostates was weakly stained. 5. These findings indicate that responsiveness to ET-1 is decreased, though the ET-1 and ET-1 receptors increase in the hyperplastic prostate. Namely, the increase in ET-1 receptors is not effective in regulating the contractile response of the prostate, because its expression is rather dominant in proliferated gland. 6. These suggest that ET-1 may not have an important role in the release of the obstructive symptoms of benign prostatic hypertrophy.

[Urothelial carcinoma of the navicular fossa]. / Urothelkarzinom in der Fossa navicularis.

We report a case of transitional cell carcinoma arising in the fossa navicularis. The patient was a 74-year-old man. He had no history of sexually transmitted disease or urethral stricture. Clinically, the tumor was suspected to be a condyloma acuminatum; however, the pathological diagnosis yielded an unexpected result: transitional cell carcinoma. Radiological examinations and cystoscopy showed no other tumor besides the primary cancer in the fossa navicularis. Partial resection of the urethra was performed and the patient has been without evidence of disease for 3 years.

Histochemical detection of intranuclear DNA fragmentation and its relation to the expression of bcl-2 oncoprotein in human prostatic cancer.

OBJECTIVE: To assess the incidence of intranuclear DNA fragmentation and the expression of the bcl-2 oncoprotein in prostatic carcinoma, both of which are related to programmed cell death. PATIENTS, MATERIALS AND METHODS: Specimens of tumour obtained from 17 patients with newly diagnosed prostatic carcinoma and 16 with hormone-treated prostatic carcinoma undergoing total prostatectomy were evaluated. DNA fragmentation was detected using the terminal-labelling method (d-uridine triphosphate conjugated with digoxigenin) and the expression of bcl-2 was detected immunohistochemically. RESULTS: There was a high incidence of intranuclear DNA fragmentation in 14 of 17 untreated tumours and 15 of 16 hormone-treated tumours. There were no differences between the positive cases in hormone-treated tumours and untreated tumours. There was significantly greater expression of bcl-2 in tumours treated with non-steroidal anti-androgen drugs (eight of nine were positive) than in those untreated (seven of 17) or treated with other drugs (one of seven) (P < 0.05). There was a consistent and marked dissociation between DNA fragmentation and bcl-2 positivity; most of the cells positive for bcl-2 showed no DNA fragmentation. CONCLUSION: The results indicated that cells positive for bcl-2 might potentially be hormone resistant and that the administration of non-steroidal anti-androgen drugs might have a role in the induction of hormone-resistant cells.

Detection of alpha 1-adrenoceptor subtypes in human hypertrophied prostate by in situ hybridization.

Adrenergic stimulation induces contraction of hypertrophied prostatic tissue via the alpha 1 adrenoceptor, and the results of pharmacological studies suggested the existence of adrenoceptor subtypes. Recently three subtypes (alpha 1a, alpha 1b, and alpha 1d) were cloned. Using probes for these subtypes, we demonstrated their expression in the tissues of ten cases of benign prostatic hypertrophy, using in situ hybridization. To determine the ratio between these subtypes, an RNase protection assay was also performed in three cases. Expression of the alpha 1a and alpha 1d adrenoceptors was diffuse in the smooth muscles of the interstitium, but was absent in glandular epithelial cells. On the contrary, the alpha 1b adrenoceptor was hardly detectable. The RNase protection assay confirmed the absence of the alpha 1b adrenoceptor, the ratio of alpha 1a and alpha 1d being 4:1. These results supported the idea that the differences in prostatic contractile response to several adrenergic drugs are based on the affinities of these drugs for the different subtypes.

[Evaluation of reliability of IPSS by 24-hour uroflowmetry].

BACKGROUND: Although the international prostate symptom score (IPSS) is now often used to assess the symptoms of BPH, whether or not patients answer the questions correctly has not been validated objectively. METHODS: Reliability of IPSS was evaluated by 24-hour uroflowmetry in 20 hospitalized male patients. Six of them had prostatic hypertrophy or cancer, and the evaluation was performed before and after TURP or hormonal therapy in these six patients. The objective scores for frequency and nocturia were obtained from the time recorded on IC card. The objective score for intermittency was calculated from the uroflow curves. RESULTS: The answer about frequency was not correct compared with the objective scores for frequency. The answers about nocturia and intermittency were almost the same as the corresponding objective scores. The answer for weak stream correlated with the average of peak flow rate. However, the threshold of peak flow rate for "weak stream" fluctuated markedly before and after the treatment in the same individuals. The answer for hesitancy had no correlation with the hesitation time. Patients seemed to understand the question translated in Japanese as "have you need force to urinate?" CONCLUSION: Before wider use of IPSS in Japan, the correct translation of the questions and verification of the usefulness of the questions in large number of Japanese patients seem necessary.

Quantitative autoradiography of alpha 1 adrenoceptors with [3H]tamsulosin in human hypertrophied prostate using computerized image analysis.

Fourteen specimens of human hypertrophied prostate were evaluated for the distribution of alpha 1 adrenoceptors using autoradiography with a computerized image analysis system. The hypertrophied prostatic specimens, obtained at open prostatectomy, were dissected vertically to the urethra, and sectioned at 10 microns. They were immersed in 1 nM of specific alpha 1 ligand, [3H]tamsulosin chloride ([3H]tamsulosin) and exposed to autoradiographic film. The images were analysed by a computerized image analysis system. The total binding of [3H]tamsulosin in the whole section (n = 14) was 0.82 +/- 0.21 (mean +/- SE) nCi mg-1. The autographic data were correlated with data obtained in a membrane-binding assay. The prostatic tissue studied was divided into urethral, glandular and stromal zones, the latter two zones being further divided into the inner and outer areas. The total binding of [3H]tamsulosin in the urethral zone (n = 7) was 0.65 +/- 0.32 nCi mg-1. The glandular zone contained significantly more abundant alpha 1 adrenoceptors than the stromal zone and their densities (glandular vs stromal) were 1.15 +/- 0.19 nCi mg-1 (n = 14) vs 0.72 +/- 0.15 nCi mg-1 (n = 14), respectively (p < 0.05). The data from the whole section were not affected by prostatic weight. This method described enabled the distribution of the receptors in different sites to be evaluated both morphologically and quantitatively.

Effect of bunazosin, alpha 1-adrenoceptor blocker, on multidirectional contractile response and localization of bunazosin binding sites in human hypertrophied prostate.

1. Effects of bunazosin, an alpha 1-adrenoceptor blocker, on the contraction induced by norepinephrine in human hypertrophied prostate were examined in vitro. 2. Prostatic specimens showed maximum contraction at 10(-4) M norepinephrine in longitudinal and circumferential directions to the urethra. 3. Bunazosin (10(-7) M) blocked norepinephrine-induced contraction with a parallel shift of the dose-response curve in both directions (pA2: 8.76 +/- 0.15; pA2: 8.90 +/- 0.08, respectively). 4. Serial sections of prostates were also evaluated by autoradiography. The binding sites were diffusely distributed in the interstitium. 5. We concluded that bunazosin affects multidirectional contraction in prostates.

[Histochemical study of biotinylated lectins in prostatic cancer].

We examined the staining pattern of various lectins in the malignant and benign prostatic tissues to clarify the difference of sugar residues of mucosubstances between them. The binding of different lectins (Concanavalia ensiformis [Con A], Triticum vulgaris [WAG], Ricinus communis [RCA-I], Arachis hypogaea [PNA], Ulex europaeus [UEA-I], Glycine max [SBA], and Gliffonia simplicifolia II [GSA-II]) to cells of benign prostatic tissues (17 cases) and adenocarcinoma (54 cases) was evaluated immunohistochemically. SBA which was negative in benign epithelial cells, showed tendency to the binding to prostatic carcinoma (42.6%). UEA-I was significantly bound to the adenocarcinoma (68.5%) compared to the benign prostatic tissue (35.3%). We also examined histochemically 25 pairs of tissues obtained from prostatic adenocarcinoma before and after the various therapies with various lectins. The histological responsiveness on the post-therapeutic specimens showed a significant correlation to the clinical responsiveness to therapy. But the staining pattern of these 7 lectins on the pre-therapeutic specimens did not show a significant correlation to the clinical responsiveness to therapy. In summary, the staining pattern of some lectins in the prostatic cancers is different from that in the benign prostatic tissues.