Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients.

STUDY DESIGN: Analysis of answers to a new questionnaire. OBJECTIVE: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. SETTING: Nationwide questionnaire survey to physicians in Japan. METHODS: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). RESULTS: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping. CONCLUSIONS: This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.

Creatinine inhibits D-amino acid oxidase.

Inhibition of D-amino acid oxidase (DAO) activity by various uremic retention products and guanidino compounds was investigated. Creatinine (CTN) was found to inhibit DAO at a similar concentration in the sera of uremic patients. The inhibition was competitive and the K(i) value was 2.7 mM. Moreover, CTN was shown to interact with flavin adenine dinucleotide (FAD), a coenzyme of DAO. The UV spectral change of FAD bound to DAO was observed in the visible region by addition of CTN. These findings suggest that the increase in serum and tissue CTN concentrations might be responsible, in part, for the increase in D-amino acids in the sera of uremic patients.

Chemiluminescence-HPLC for the assay of guanidino compounds.

A chemiluminescence-HPLC system for the assay of serum guanidino compounds was established. In this study, we found that lucigenin added to the reaction mixture containing guanidino compounds and alkaline-ninhydrin reagent resulted in strong chemiluminescence. The lucigenin chemiluminescence was not derived from fluorescent derivatives of guanidino compounds or ninhydrin. The interaction of guanidino compounds and ninhydrin under alkaline conditions produced reactive oxygen species. We applied this phenomenon to the microanalysis of guanidino compounds.

Automatic system for the assay of guanidino compounds to assess uremic status.

An automated system for HPLC-fluorometry of serum guanidino compounds was constructed. This system accomplished simultaneous removal of protein and uremic fluorescences, abundant in the sera of uremic patients, which interfere with the fluorometric assay. This system was applied to the detailed elucidation of the behavior of guanidinosuccinic acid and methylguanidine during and after hemodialysis therapy (HD). The uremic patients who are capable of excreting urine even under hemodialysis therapy showed low serum guanidinosuccinic acid and methylguanidine levels. The prolongation of the interval between HD for one of the patients capable of excreting urine was examined. The levels of guanidinosuccinic acid and methylguanidine did not significantly increase and no hazardous effect was observed by 2 d of prolongation.

Action of chondroitinase ABC on epidurally transplanted nucleus pulposus in the rabbit.

STUDY DESIGN: After autotransplanting the nucleus pulposus into the epidural space of rabbits, chondroitinase ABC was administered, and the effect of chondroitinase ABC was examined. OBJECTIVES: To examine whether chondroitinase ABC accelerates resolution of the nucleus pulposus transplanted into the epidural space. SUMMARY OF BACKGROUND DATA: No previous reports exist on the effect of chondroitinase ABC on the nucleus pulposus in the epidural space. METHODS: In Study 1, autotransplantation of the nucleus pulposus into the epidural space was performed in rabbits. Histologic change was observed. In Study 2, dry weight, deoxyribonucleic acid content, and the amount of glycosaminoglycans of autotransplanted nucleus pulposus were quantified and compared with the respective values in the control group, chondroitinase-ABC-injected group, and phosphate-buffered saline-injected group. In Study 3, granulocytes obtained from the blood of a rabbit treated with chondroitinase ABC or phosphate-buffered saline were added to the nucleus pulposus taken from the same rabbit. RESULTS: In chondroitinase ABC group, inflammatory cells tended to infiltrate earlier than those in the control group (Study 1). The dry weight of recollected nucleus pulposus in the chondroitinase ABC group was significantly less than in the other groups. Deoxyribonucleic acid content in the nucleus pulposus tended to be larger in the chondroitinase ABC group, although no significant difference in content compared with that in the other groups was found. Regarding the residual glycosaminoglycans in the transplanted nucleus pulposus, the amount of chondroitin sulfate markedly decreased in the chondroitinase ABC group (Study 2). The number of granulocytes infiltrating the nucleus pulposus was distinctly large in the chondroitinase ABC group (Study 3). CONCLUSION: Chondroitinase ABC can enhance resolution of the nucleus pulposus in the epidural space.

Automatic system for the assay of guanidino compounds to assess uremic status and effect of hemodialysis.

An automated HPLC system coupled with fluorometry was established for the sensitive, rapid, and accurate assay of serum guanidines. Naturally fluorescent materials characteristic of the sera of uremic patients (uremic fluorescences) which interfere with the assay were removed simultaneously with deproteinization. Application of this method revealed that the uremic patients who are capable of excreting urine under hemodialysis therapy show low serum guanidinosuccinic acid levels. The interval between hemodialysis sessions in one of these patients was prolonged while monitoring guanidinosuccinic acid level using the present method without any hazardous effect.

[Serum globulin levels and activities of daily living in centenarians].

Serum globulin levels in 101 centenarians (77 women, 24 men) were analyzed by zonal electrophoresis and immunoglobulin assays. Six subjects showed an M band in electrophoretograms. Five M bands were immunoglobulin G (IgG) type and one was IgA. One subject was suspected to suffer from IgG-type multiple myeloma, and the others were thought to have essential (benign) monoclonal gammopathy. The relationship between serum globulin levels and activities of daily living (ADL) was studied in remaining 95 subjects. There were 21 rank-J (free-living), 25 rank-A (unable to go outside without help), 23 rank-B (bedridden but able to sit on the bed), and 26 rank-C (completely bedridden) centenarians. The mean serum alpha 1-, alpha 2-, and beta-globulin level in the rank-J centenarians was at the upper limit of the normal adult range. The mean alpha 1-globulin levels in rank-B (3.3 +/- 0.4%) and C (3.4 +/- 0.5%) subjects were significantly higher than those in rank-J (2.9 +/- 0.3%) centenarians. The mean serum gamma-globulin level of rank-J centenarians (16.9 +/- 3.7%) was within the normal range. The mean gamma-globulin levels in rank-B (21.0 +/- 2.7%) and C (22.8 +/- 4.9%) subjects were significantly higher than that in rank-J centenarians. The mean immunoglobulin G concentrations in rank-B (1.620 +/- 304 mg/dl) and C (1.720 +/- 392 mg/dl) subjects were significantly higher than those in rank-J centenarians (1.320 +/- 361 mg/dl) and in normal adults (1.150 +/- 235 mg/dl). IgA concentrations in all centenarians were higher than in normal controls. There was no significant difference in IgA or IgM concentration between rank-J subjects and those in other ranks. Serum globulin levels measured with electrophoresis, and the immunoglobulin concentrations, can be valuable indicators of the ability to perform activities of daily living, and may be useful predictors of subclinical diseases or morbidity in centenarians.

[Serum albumin level and activities of daily living in centenarians].

The relationship between serum albumin level and activities of daily living was studied in 95 centenarians. There were 73 women (12 rank J: free-living, 18 rank A: unable to go outside without help, 20 rank B: bedridden but able to sit on the bed, 23 rank C: completely bedridden) and 22 men (9 rank J, 7 rank A, 6 rank B or C). The serum albumin level (mean +/- S.D. 4.0 +/- 0.4 g/dl) of the rank J women was at the lower limit of normal for young adults. The albumin levels of rank A, rank B, and rank C were 3.7 +/- 0.4 g/dl, 3.5 +/- 0.3 g/dl, and 3.4 +/- 0.4 g/dl, respectively. The levels of rank B and rank C women were significantly lower than that of rank J women. The albumin level of rank J men (3.9 +/- 0.3 g/dl) was lower than that of young adults. The albumin level of ranks B and C men (3.1 +/- 0.3 g/dl) was significantly lower than that of rank J men. The A/G ratio or albumin fraction (%) measured by serum electrophoresis was similar to that of the serum albumin level of centenarians of both sexes. There were no significant differences in the serum protein level or in the peripheral hemoglobin level between rank J centenarians and those of other ranks, for both sexes. The serum albumin level is a valuable indicator of the ability to perform activities of daily living and may be a useful prognostic index in centenarians.

Numerical and functional characteristics of lymphocyte subsets in centenarians.

The immune system in the aged is a very interesting subject for study. In this study, analysis was extended to extrathymic T cells as well as NK cells and "conventional" T cells (i.e., thymus-derived T cells) in terms of their constitution and function in both healthy and unhealthy centenarians. Middle-aged persons were used as controls. Healthy and unhealthy centenarians showed lower levels in the proportion and absolute number of lymphocytes. The major change in the constitution of lymphocyte subsets was increased levels in the proportion of NK cells (CD56+/CD57+) and extrathymic T cells (CD3+CD57+). Inversely, conventional T cells decreased in proportion and function (i.e., proliferative response to mitogen). Although NK cells increased in centenarians, NK activity by whole lymphocytes and the purified NK fraction decreased. The difference between healthy and unhealthy centenarians was small in all parameters, the only difference being a lower level of expression of CD56 antigens on CD57+ T cells in unhealthy centenarians. These results indicate that there is a major shift in lymphocyte population from conventional T cells to NK cells and extrathymic T cells with aging. Concerning the age-associated increases in CD56+ T and CD57+ T cells, these cells correspond to NK1+ T cells in mice.

[Family history and the frequency of human leukocyte antigen (HLA-DR) in centenarians].

There are a few reports that associate several loci of the human leukocyte antigen (HLA) with longevity, such as DR1 which is significantly frequent in the very old, especially in Okinawa centenarians. In contrast DR9 is decreased. This report investigates 87 healthy Okinawan centenarians and 148 healthy Okinawan controls examined since 1987 with HLA phenotyping and family history questionnaires. The mean age in centenarians was 101.6 years, and that of controls was 66.4. We inquired the age and the cause of death of the parents of the subjects. Subjects whose parent's deaths were by suicide, homicide, accident, war or due to war trauma, were excluded and only those resulting from illness or natural causes were included. The relation between age of death of parents and DR types were studied. Compared to controls, DR1 was significantly increased in the centenarians (p = 0.036, RR 4.239), and DR8 was decreased (p = 0.012, RR = 0.412). When the mean age of death of parents for each DR group and that of total was determined, the mean death age of those with DR9 was significantly lower than the mean of the total (p < 0.05). More over, when the frequency rate of the DR types were compared with the parents' death age, that of DR9 decreased as the age of death increased. It is suggested that some loci of HLA-DR relate to longevity and some genetic protection against immunorelated diseases contributes to long-lived lineage.

Sesame seed lignans and gamma-tocopherol act synergistically to produce vitamin E activity in rats.

Vitamin E activity of sesame seed, which contains only gamma-tocopherol, a compound that has vitamin E activity equal to only 6-16% that of alpha-tocopherol, was examined in two experiments. In the first experiment, groups of rats were fed four diets: vitamin E-free control diet, alpha-tocopherol-containing diet, gamma-tocopherol-containing diet and sesame seed-containing diet. Changes in red blood cell hemolysis, plasma pyruvate kinase activity, and peroxides in plasma and liver, as indices of vitamin E activity, were examined. The sesame seed diet has high vitamin E activity, whereas this activity was low in the gamma-tocopherol diet. In plasma and liver, alpha-tocopherol was found in high concentration only in the alpha-tocopherol-fed group, and gamma-tocopherol was found in high concentration only in the sesame seed-fed group, with negligible amounts of gamma-tocopherol in liver of the gamma-tocopherol-fed group. In the second experiment, two diets containing sesame lignan (sesaminol or sesamin) and gamma-tocopherol were tested. Results in both of the sesame lignan-fed groups were comparable to those observed in the sesame seed-fed group in Experiment 1. These experiments indicate that gamma-tocopherol in sesame seed exerts vitamin E activity equal to that of alpha-tocopherol through a synergistic interaction with sesame seed lignans.

Lymphatic drainage of epidural space in rabbits.

Epidural lymphatic drainage was examined using epidural catheterization and an infusion of india ink. The india ink was drained quickly through a connecting lymphatic vessel from the nerve root foramen to the anterior lumbar lymphatic vessels. Many kinds of epidurally administered agents may be drained in this manner.

Comparison of atrophic and goitrous auto-immune thyroiditis in children: clinical, laboratory and TSH-receptor antibody studies.

We studied the clinical features, laboratory and thyroid functions and thyrotropin (TSH)-receptor and thyroid-stimulation antibodies in 21 patients with atrophic auto-immune thyroiditis (AAT) and 48 patients with goitrous auto-immune thyroiditis (GAT) of childhood onset. The clinical features of patient with AAT were cessation of growth and obesity, while asymptomatic enlargement of the thyroid gland was the sole symptom in most patients with GAT. Although the ages at diagnosis were comparable in both groups, the estimated ages at onset were much lower in patients with AAT than in those with GAT. Patients with AAT exhibited more severe hypothyroidism when evaluated by serum thyroxine (T4), tri-iodothyronine (T3), TSH, cholesterol levels and basal metabolic rates. The 24 h 123I-thyroidal uptake was significantly lower in patients with AAT than in those with GAT. None of the 19 patients with AAT possessed TSH-binding inhibitor immunoglobulins (TBII). On the other hand, 3 of the 32 GAT patients tested, possessed weak to potent TBII activities. Three TBII-positive patients with GAT also possessed thyroid-stimulation blocking antibodies. These findings suggest that: 1. Pathogenesis of AAT in children whose onset of hypothyroidism was before puberty is not due to TSH-receptor blocking antibodies, which are often found in patients with AAT of postpubertal onset. 2. AAT in children is considered not to be due to the later stage of GAT. 3. Some patients with GAT possessed TSH-receptor blocking antibodies. The aetiology and pathogenesis of AAT in children have yet to be elucidated.

Primary myxedema with thyrotrophin-binding inhibitor immunoglobulins. Clinical and laboratory findings in 15 patients.

In a screening of 43 patients with primary myxedema, 9 patients were found to have IgG that inhibits the binding of 125I-thyrotrophin to its receptor (thyrotrophin-binding inhibitor immunoglobulins). Preparations of IgG from these patients did not stimulate thyroidal cyclic adenosine monophosphate generation and blocked thyroid stimulation by thyrotrophin in vitro. Clinical and laboratory features of 15 patients with this inhibitor, including 6 who were previously known, were compared with those of patients without the inhibitor. The patients with inhibitor, 2 men and 13 women, had onset of their hypothyroidism from age 2 to 49 years, and thyroid uptake in these patients was significantly lower than that in patients without inhibitor. Transient hypothyroidism was seen in all 5 infants born to 4 mothers having potent inhibitor immunoglobulins. These clinical findings indicate that thyrotrophin-receptor-blocking antibodies play a pathogenic role in a group of patients with primary myxedema.

[Insulin, glucagon and growth hormone responses during glucose, arginine and insulin tolerance tests in children with hyperthyroidism].

There are many reports of glucose intolerance in adult patients with hyperthyroidism but few reports of glucose intolerance in hyperthyroid children. In this study, we measured plasma levels of glucose, insulin, glucagon and growth hormone in hyperthyroid children and control subjects by the use of three kinds of tolerance tests: an oral glucose tolerance test, an arginine tolerance test and an insulin tolerance test. In the oral glucose tolerance test, mean fasting glucose levels (79.6 +/- 1.4 mg/dl) rose to maximum levels (157.3 +/- 4.3 mg/dl) at 30 min in hyperthyroid children which were significantly higher than the levels in control subjects (p less than 0.01). The maximum levels of glucose fell slowly and returned to fasting levels at 180 min. In this test, plasma insulin levels increased from basal levels (12.7 +/- 1.9 microU/ml) to maximum levels (120.8 +/- 22.1 microU/ml) at 30 min in the prepubertal age group of hyperthyroidism. On the other hand, in the pubertal age group of hyperthyroidism, maximum levels of insulin were observed at 60 min, but not at 30 min. These maximum levels of insulin of both hyperthyroid age groups were significantly higher than those in the control subjects (p less than 0.05, p less than 0.01 respectively). There was no difference in insulin-glucose ratio at 30 min (delta IRI/delta BG) and insulinogenic index (I.I.) at 0 to 60 min between these two groups of hyperthyroid children and control subjects. However, I.I. at 0 to 120 min and 0 to 180 min decreased significantly in the pubertal age group of hyperthyroidism as compared with those in the control group (p less than 0.05, p less than 0.02 respectively). In the oral glucose tolerance test, plasma glucagon levels decreased from basal levels (74.1 +/- 4.3 pg/ml) to minimum levels (36.4 +/- 4.7 pg/ml) at 90 min in hyperthyroidism, which were significantly lower than those in the controls (p less than 0.05). However, there was no difference in -epsilon delta IRG/epsilon delta BG (cumulative glucagon response/cumulative glucose response) between the subjects with hyperthyroidism and the controls. On the other hand, lower responses of blood glucose, insulin, glucagon and growth hormone to arginine were observed in subjects with hyperthyroidism than in the controls. Moreover in the insulin tolerance test, there was no difference in glucagon and growth hormone response between the subjects with hyperthyroidism and the controls. Thus our conclusions are as follows: A marked increase in blood glucose after oral glucose load was observed in spite of normal insulin-glucose ratio in hyperthyroid children, suggesting the existence of peripheral insulin resistance.(ABSTRACT TRUNCATED AT 400 WORDS)

Distraction rod instrumentation with posterolateral fusion in isthmic spondylolisthesis. 53 cases followed for 18-89 months.

Fifty-three cases of isthmic spondylolisthesis were treated with distraction rod instrumentation and posterolateral fusion with or without nerve root decompression, and they were followed for an average of 39 months. Thirty-one cases without neurologic deficit were treated with instrumentation and fusion only. In 22 cases of predominant sciatic pain with neurologic deficit signs, nerve root decompression and instrumentation with fusion were conducted. The results showed a 90.6% solid union rate with satisfactory clinical improvement. Realignment of the vertebral displacement such as reduction of olisthesis and widening of the olisthetic disc spaces was obtained to some extent. No serious complications were encountered.