Diversity and variability of smooth muscle phenotypes of renal arterioles as revealed by myosin isoform expression.

The contractility and distensibility of renal arterioles are important in the regulation of glomerular filtration. However, little is known regarding the characteristics of contractile proteins in these arterioles. Recently it was demonstrated that vascular smooth muscles contain two types of myosin heavy chain (MHC) isoforms, SM1 and SM2, which are unique molecular markers of smooth muscle cell phenotypes. SM1 is constitutively expressed in all types of smooth muscles, whereas SM2 exists only in mature smooth muscles. We characterized the expression of MHC isoforms as well as the ultrastructural myofilament assembly of renal arteriolar smooth muscles in human, rat and rabbit by immunohistochemical techniques. SM1 and alpha-smooth muscle actin were localized in both the preglomerular vessels (including the afferent arterioles) and efferent arterioles, whereas SM2 was present only in the preglomerular vessels. Renin-producing cells in the afferent arterioles (juxtaglomerular granular cells, JG cells) were positive for alpha-smooth muscle actin but negative for SM2. When renin synthesis was stimulated, the more proximal afferent arteriolar smooth muscles turned renin-positive and SM2 disappeared. Glomerular mesangial cells did not show immunoreactivities for SM1, SM2 or alpha-smooth muscle actin. The difference in MHC isoform expression in these arterioles was also reflected by ultrastructures; the afferent arteriolar smooth muscles contained abundant myofilaments including thick filaments, whereas the efferent arteriolar smooth muscles had a few myofilaments composed only of thin microfilaments. The JG cells displayed a myofilament assembly similar to that in the efferent arteriolar smooth muscles. We conclude from these observations that smooth muscles in pre-and postglomerular arterioles, the glomerular mesangial cells and JG cells differ in phenotypes, suggesting that they may have different contractile properties which may be critically involved in the regulation of glomerular filtration.

[Evaluation of advanced bladder tumor].

Ninety-two cases of advanced bladder tumor treated at the University of Tokyo and branch hospital from January 1977 to December 1992 were analyzed. The advanced bladder tumor was defined as that of higher than pT2 (according to the General Rule for Clinical and Pathological Studies on Bladder Cancer) or that with distant metastases. The following variants were evaluated, the therapeutic methods, the histological type, grade, stage, type of infiltration. The evidence of lymphatic infiltration, vessel infiltration, and lymph node metastases were also reviewed. The survival rate was calculated using Kaplan-Meier's method. In the cases with lymph node metastases, the survival rate was significantly lower than in the cases without metastases (p < 0.01), while no other factors affected the survival rate.

[Consecutive annual changes in minimum inhibitory concentration in clinically isolated Neisseria gonorrhoeae strains].

Between 1983 and 1991, 465 gonococcal strains isolated in the urological department of Japanese Red Cross Medical Center. The minimum inhibitory concentration (MIC) of these isolates to 22 kinds of antibiotics including penicillins (PC), cephems, tetracyclins (TC) and new quinolons (NQ) were determined and the annual difference of MIC was studied. The annual incidence of penicillinase producing neisseria gonorrhoeae (PPNG) of these 9 years were distributed in 3 to 17% and increasing tendency was not observed. As for Penicillin G, the MIC 90 of PPNG was seven fold higher than that of non-PPNG. No remarked difference was observed between MIC 90 of Cephems, TC and NQ of PPNG and non-PPNG. No annual difference was observed in MIC of PC, Cephems and SPCM. However the rising tendency of MIC was observed in NQ.

[Comparative study on minimum inhibitory concentration of gonococcal strains according to their auxogroups and serovars].

Auxotypes, serovars and minimum inhibitory concentration (MIC) of various antibiotics are investigated on 85 gonococcal strains isolated from the patient with gonorrhea from 1984 to 1986 in Japanese Red Cross Medical Center. As to the auxotypes 33 strains were identified to be Proto, 33 to be Pro, 10 to be Arg and 9 to be PAU. No AHU strain was identified. Serovars were divided into 1A and 1B. MIC of 22 kinds of antibiotics including penicillins, cephems, spectinomycin, tetracycline and new quinolones were determined. Cumulative MIC curves were found to be shifted to the right according to the order of auxotypes Arg, PAU, Proto, Pro in the most antibiotics. Serovar 1A was found to have lower MIC as compared to 1B, though only 5 strain of 1A were in the study. Seventy-eight % of isolates were Proto or Pro, so-called Asian auxotype which were revealed to have higher MIC not only of penicillin but also of the other antibiotics. Nine strains were identified as PAU which was lately identified in Canada. This might suggest that gonococcal strains are spreading over the world in spite of the local predominance of auxotype distribution.

[Treatment of advanced prostatic cancer--chronological change between 1975 and 1991].

A chronological analysis of the clinical features and treatments of advanced prostatic cancer, stages C and D, was performed in 154 cases treated from 1976 through 1991. These cases were divided into two chronological groups: 61 cases treated between 1976 and 1983, and 93 cases between 1984 and 1991. Concerning demographic features and diagnosis, the number of patients with lymph node metastasis was higher in the latter group. There was also increase in cases who were urologically asymptomatic and detected by checkup digital rectal examination or by the elevation of serum prostatic tumor markers. Histopathological differentiation was consistent between the two groups; more than 70% of cancers were moderately and poorly differentiated adenocarcinoma. As for the treatment, total prostatectomy was performed in eight cases in the latter against none in the earlier, but hormonal therapy remained the main treatment throughout the periods: 74.2% in the earlier and 70.7% in the latter. However the methods of the therapy have clearly changed; estrogens and castration were used less often in the latter period, while LH-RH analogues and antiandrogens replaced them although the therapy was equally effective in 82.3% of the cases in the earlier and in 90.4% in the later period and five-year survival rate and the progression-free survival rate at three years showed no significant difference between the two periods. These results showed 1) refined quality of diagnosis 2) a change in mode of hormonal therapy and 3) no detectable improvement of survival in these 16 years. Development of more effective therapies would be warranted for a better survival.

[Clinical observations of advanced renal cell carcinomas--the chronological change between 1975 and 1991].

An analysis has been undertaken to determine chronological changes that have occurred in the clinical features and treatments of advanced renal cell carcinomas. To accomplish this, 96 renal cell carcinoma cases, handled by the authors' department and at the branch hospital, were divided into two groups: 48 patients treated between 1975 and 1983 (group 1) and 48 patients treated between 1984 and 1991 (group 2). Between the two groups, no differences were seen in the sex ratio, the mean age, and the ratio of those who were found to be advanced cases at the time of diagnosis and those whose cancers had advanced after undergoing a nephrectomy. Concerning treatment, interferon (IFN) and UFT were more frequently used in treating group 2 than group 1, and chemotherapy, radiotherapy, and endocrine therapy less frequently used. No differences were seen in the prognosis between the two groups; however, in those who had advanced after nephrectomy, group 2 cases survived for a significantly longer period than did group 1 cases. Patients who survived for 5 years or longer accounted for two cases in group 1 and 5 cases in group 2 and combination therapies involving surgery, IFN, UFT, or similar medications were used for their treatments. These results suggest that adjuvant therapies, such as surgery, IFN, and UFT, have possibly contributed to prolonging survival, especially for cases that advanced after nephrectomy.

[Effects of recombinant human granulocyte colony-stimulating factor on superoxide production by neutrophil in cancer patients receiving chemotherapy].

The in vivo effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the number and function of peripheral neutrophils were studied in time sequence in 9 cancer patients receiving anticancer cytotoxic chemotherapy; 6 patients with transitional cell carcinoma of urothelium treated with CAP (the combination of cyclophosphamide, adriamycin and cisplatin) and the other 3 with testicular tumor treated with PEB (the combination of cisplatin, etoposide and bleomycin). The neutrophil function was evaluated by superoxide production, measuring chemiluminescence of the neutrophil suspension by a photometer. In the 1st course, when no rhG-CSF was administered, the neutrophil function declined significantly (p < 0.01) as the peripheral neutrophil count (PNC) decreased, reached the minimum almost at the same day as PNC reached the nadir, and returned to the normal level at the beginning of the next course. In the 2nd course, when rhG-CSF (75 micrograms/body) was administered subcutaneously daily for 14 consecutive days beginning at 72 hours after the chemotherapy, the nadir of neutropenia was elevated (p < 0.01), the period of neutropenia (< 1,000/mm3) was shortened (p < 0.01), the recovery from neutropenia (> 1,500/mm3) was accelerated (p < 0.01) as compared to the 1st course, and an marked increase of PNC (p < 0.01) to the peak on the next day of the last administration of rhG-CSF was observed. In addition, deterioration of neutrophil function was alleviated (p < 0.05) and the neutrophil function was enhanced (p < 0.01-0.05) during rhG-CSF administration, even at the nadir of neutropenia.(ABSTRACT TRUNCATED AT 250 WORDS)

Advantage of a smaller caliber fiberscope and learning curve on transurethral lithotripsy.

Transurethral lithotripsy was performed in 63 patients with ureteral calculi between September 1987 and March 1991. Three types of flexible nephroureteroscopes with diameters of 12.8F, 10.5F and 9.3F were used in groups 1, 2 and 3, respectively. The rate of successful stone disintegration and the stone-free rate 3 months after lithotripsy were 73% (11 of 15 patients) and 67% (10 of 15), respectively, in group 1, 93% (26 of 28) and 82% (23 of 28), respectively, in group 2, and 95% (19 of 20) and 85% (17 of 20), respectively, in group 3. Four complications were encountered in the patients treated with the 12.8F device (group 1). Our results clearly show that use of a slimmer fiberscope and the effect of learning to perform techniques with the flexible nephroureteroscope improved the success rate and decreased the complication rate in transurethral lithotripsy.

[Comparative study of cefpirome and ceftazidime in complicated urinary tract infections].

We carried out a randomized multi-center study comparing cefpirome (CPR) 0.5 g b.i.d. (1 g group), 1.0 g b.i.d. (2 g group) and ceftazidime (CAZ) 1.0 g b.i.d. (CAZ group) in the treatment of complicated urinary tract infections. Patients who were over 16 years old and had underlying urinary tract disease, with bacteriuria of more than 10(4) cells ml or more and pyuria of more than 5 WBCs/hpf (x 400) or more were randomly allocated to receive either 0.5 g of CPR, 1.0 g of CPR or 1.0 g of CAZ twice a day for 5 days by intravenous drip infusion. The overall clinical efficacy of the treatment was evaluated by the criteria of the Japanese UTI Committee as excellent, moderate or poor, on the basis of the changes in pyuria and bacteriuria. A total of 530 patients were treated. Of these, 141 patients in the 1 g group, 136 in the 2 g group, and 140 in the CAZ group were evaluable for clinical efficacy. No significant differences in background characteristics were observed among the treatment groups. The overall clinical efficacy rate of the 1 g group, the 2 g group and the CAZ group was 80.1%, 76.5% and 71.4%, respectively. The differences were not statistically significant. The overall bacteriological eradication rate of the 1 g group, the 2 g group and the CAZ group was 81.0%, 88.1% and 83.8%. The differences were not statistically significant either. Against the enterococcus group, however, eradication rates were higher significantly in the 1 g and 2 g groups than in the CAZ group. The incidence of adverse reactions was 2.2% in the 1 g group, 0.6% in the 2 g group and 2.9% in the CAZ group. Abnormal laboratory data after medication were observed in 10.8% of the 1 g group, 12.1% of the 2 g group and 10.2% of the CAZ group, the difference not being statistically significant. There were no serious untoward reactions to medication. From the results obtained in this study, we consider that CPR is at least as useful as CAZ in the treatment of complicated urinary tract infections.