Surgical challenge in patients who underwent failed hypospadias repair: is it time to change?

INTRODUCTION: Our purpose was to evaluate patients who underwent failed hypospadias repair. PATIENTS AND METHODS: We evaluated 4 different groups of patients who underwent failed hypospadias repair. Group 1: patients who underwent only urethral surgery; group 2: patients who underwent only corpora cavernosa surgery; group 3: patients who underwent urethral and corpora cavernosa surgery; group 4: patients who underwent complex reconstructive surgery. Success was defined as a functional urethra without fistula, with glandular meatus and acceptable esthetic appearance of the genitalia. RESULTS: Out of 1,176 patients, group 1 included 301 patients (25.5%), group two 60 patients (5.2%), group three 166 patients (14.1%) and group four 649 patients (55.2%). The mean follow-up was 60.4 months. Out of 1,176 cases, 1,036 (88.1%) were considered successful and 140 (11.9%) failures. CONCLUSION: In the majority of patients (55.2%) with failed hypospadias repair, urethral reconstruction is associated with complex surgical procedures to fully resurface glands, penile shaft and genitalia.

Successful surgical correction of an extreme form of ectopic penis.

Reported here is the successful multi-staged repair of a rare case of complete penoscrotal transposition with ectopic penis. The need to evaluate for associated anomalies is discussed.

Urethral Lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap.

OBJECTIVES: To develop a technique for urethral reconstruction using a combined labia minora flap and buccal mucosa graft. Urethral lengthening is the most difficult part in female transsexuals and poses many challenges. METHODS: From April 2005 to February 2008, 38 patients (aged 19-53 years) underwent single-stage metoidioplasty. The technique starts with clitoral lengthening and straightening by division of both clitoral ligaments dorsally and the short urethral plate ventrally. The buccal mucosa graft is quilted to the ventral side of the corpora cavernosa between the native orifice and the tip of the glans. The labia minora flap is dissected from its inner surface to form the ventral aspect of the neourethra. All suture lines are covered by the well-vascularized subcutaneous tissue originating from the labia minora. The labia majora are joined in the midline and 2 silicone testicular implants are inserted to create the scrotum. The neophallus is covered with the remaining clitoral and labial skin. RESULTS: The median follow-up was 22 months (range 11-42). The median neophallic length was 5.6 cm (range 4-9.2). The total length of the neourethra was 9.4-14.2 cm (median 10.8). Voiding while standing was reported by all 38 patients, and temporary dribbling and spraying were noted by 12. Two fistulas and one urethral erosion resulted from the testicular implant and required secondary revision. CONCLUSIONS: A combined buccal mucosa graft and labia minora flap present a good choice for urethral reconstruction in female-to-male transsexuals, with minimal postoperative complications.

Prevention of cervical cancer with screening programme in Branicevo District and cost-effectiveness analysis adjusted to the territory of the Republic of Serbia.

PURPOSE: To establish the so-called positive screening instead of the current opportunistic screening for cervical cancer. PATIENTS AND METHODS: The program of positive screening covered all female persons aged 30-49 years living in the Branicevo District. All women were sent an invitation to participate in the screening and those who responded had Papanicolaou smear test done on the results of which further diagnostic procedures would be determined. RESULTS: The invitation to examination was responded by 11,200 (48.70%) out of 23,000 women invited. The costs of organized screening per capita amounted to Republic of Serbia dinar (RSD) 380.00 (EUR 4.75). 954 patients in total underwent colposcopy and conization, resulting in RSD total costs of 11,926,373.70 (149,079.00 EUR). Assuming the same incidence rate among the population that did not respond to the invitation, the number of women that would have such an intervention would be increased by 893. CONCLUSION: One-year screening programme is more effective than 3-year programme (180 lives saved compared to 113), but more expensive. This is our cost-effectiveness analysis (CEA) relevant opinion, but not for adoption in practice.

One-stage repair of severe hypospadias using combined buccal mucosa graft and longitudinal dorsal skin flap.

AIM OF THE STUDY: Urethral reconstruction in severe hypospadias presents a great challenge. We evaluated a method of combining longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in the most severe hypospadias. Our aim was to repair the most difficult cases in a one-stage procedure. METHODS: Between January 2003 and July 2007, 23 patients (aged from 9 to 26 months) underwent repair of severe hypospadias (18 penoscrotal and 5 scrotal forms). The short urethral plate is divided in all cases and the remaining curvature was repaired by dorsal plication. The buccal mucosa graft is harvested and fixed to the ventral side of corpora cavernosa to form the first half of the neourethra. A longitudinal dorsal island skin flap is created and buttonholed ventrally. It is sutured to the buccal mucosa graft to form the neourethra. An abundant flap pedicle is fixed laterally to cover all the suture lines of the neourethra. Penile skin reconstruction is done using available penile skin. RESULTS: The mean follow-up was 27 (range 11-66) months. Satisfactory results were achieved in 20 patients. There were two urethral fistula and one temporary distal urethral stricture. CONCLUSION: A combined longitudinal island skin flap and buccal mucosa graft could be a good choice for single-stage urethral reconstruction in the repair of the most severe hypospadias.

[Penile- and urethral anomalies]. / Penis- und Harnröhrenmissbildungen.

Penile and urethral anomalies are common congenital disorders with some rare variations. For example, the floppy penis is dealt with in only a few publications with a small numbers of cases. Other anomalies have not been published at all, i.e., the ectopic penis. Some anomalies become apparent immediately at birth, others remain undiscovered until adolescence. To date there is no established classification system dealing with urethral and penile anomalies. Also, no established guidelines exist for diagnosing and treating these anomalies. Surgical corrections of penile and urethral anomalies should follow standardized procedures on the one hand, but must respect the individual anatomical situation on the other. Since genital anomalies are frequently part of a syndrome, interdisciplinary approaches are advisable. The following article presents a classification of penile and urethral anomalies. Since posterior urethral valves usually affect the bladder and upper urinary tract, this disorder is not included in this review.

Continent appendicostomy in the treatment of fecal incontinence.

BACKGROUND: Fecal incontinence is common in children with anorectal anomalies or spina bifida. If it is possible to achieve fecal control, patients are given a large volume of enema once a day. Retrograde enemas are often unpleasant in children, particularly in adolescents. Malone procedure of antegrade appendicostomy achieves antegrade colonic irrigation. MATERIAL AND METHODS: From 1996 to 2003 Malone antegrade appendicostomy was performed in 10 patients with fecal incontinence. The patients were aged from 5 to 24 years. In 4 patients fecal incontinence was due to an anorectal anomaly, and in 6 patients spina bifida. Preoperatively, all patients were given a clysma to control fecal incontinence. The patients, who remained clean with regular usage of the clysma for 24 hours or longer, fulfilled the criterion for the formation of continent appendicostomy. In 9 patients the cecal appendix was used to create a stoma, while in another one a lateral tubularized cecal flap was applied. In 3 patients a continent conduit was also done due to urinary incontinence. The follow-up period was from 1 to 8 years. A patient was reoperated due to stenosis of the stomal aperture, while another one has not been using the stoma because of social reasons. CONCLUSION: Continent appendicostomy is a simple surgery, which is effective in the control of fecal incontinence in most children. It is indicated only in patients in whom the rerograde clysma successfully cleans the colon and if patient and parents are motivated to use it. Possible complications, among which stenosis is the most frequent, can be solved with a reoperation.

[Our experience in the Martius method of closing the vesicovaginal fistula]. / Nasa iskustva u zatvaranju veziko-vaginalne fistule po Martius-u.

Sometimes after delivery, gynecological or other surgeries, radiological therapy, or destructions of vesico-vaginal septum due to the tumor or trauma, the unnatural communication between the bladder and vagina occurs. Those are fistulas that occur after the delivery (tocogenic) caused by the prolonged delivery or some obstetrics operations. Some fistulas are high, coming from the fundus of the bladder, medium, if they come just behind the trigonum of the bladder, and low, if they are in the level of trigonum and the neck of the bladder. The purpose of this paper is to show the operative technique of elimination of medium and low vesicovaginal fistula and the results of the treatment. Material and method The elimination of the vesicovaginal fistula by original Martius technique is done through vagina. The catheter is inserted through the fistula (figure 1). Than the mucosis of the vagina is cut around the fistula and the vaginal wall is separated from the bladder. The catheter is pulled out and the fistula on the bladder is sown with resorptive stitches. Than the labia maiora nearer to the fistula is cut along from Mons Veneris to the middle and the lipoid tissue is taken with vascular pedicle (figure 2). This tissue is put between the bladder and the vagina and fixed with resorptive stitches. After that the vagina is sown by single stitches. The labia maiora that was cut is also sown by single stitches (figure 3). Than the catheter is inserted in the bladder that should stay there for four weeks. This is the method we used to make surgery in twenty patients with vesicovaginal fistula. The first one had the fistula as the result of the Caesarean section. She was operated twice through the bladder without success. The second patient was a fourteen years old girl that cut herself on the glass and damaged anal sfincter, rectum, vagina and the bladder. The fistula appeared later in the level of trigonum of the bladder. The other eighteen patients got fistula after hysterectomy. All patients were treated as described above and fistulas disappeared. The first patient had another baby a year after the operation by Caesarean section. The other patients have regular miction (figure 4 and 5). Discussion and the conclusion Vesicovaginal fistula are serous complications, for the patients and for the doctors. The only treatment of the vesicovaginal fistula is surgical. If any damage of the bladder occurs during any operation it should be treated immediately, otherwise the fistula will appear. The treatment depends of the localization of the fistula. Low fistulas and some medium and urethrovaginal fistulas should be approached through vagina and according to our experience Martius's method is very efficient. The only important thing is when the fistula is detected to wait at least for two or three months for the fistula to "consolidate" and also to cure the infection.

Metoidioplasty: a variant of phalloplasty in female transsexuals.

OBJECTIVE: To describe metoidioplasty, a technique for creating a neophallus from an enlarged clitoris in female transsexuals, without needing the complex, multi-staged surgical construction of a large phallus, as this reconstruction is one of the most difficult in female transsexuals. PATIENTS AND METHODS: From September 1995 to April 2002 metoidioplasty was used in 22 patients (aged 18-33 years). The technique is based on the repair of the most severe form of hypospadias and intersex. The 'urethral plate' and urethra are completely dissected from the clitoral corporeal bodies, then divided at the level of the glanular corona, and the clitoris straightened and lengthened. A longitudinal vascularized island flap is designed and harvested from the dorsal skin of the clitoris, transposed to the ventral side, tubularized and anastomosed with the native urethra. The new urethral meatus is brought to the top of the neophallus, and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. RESULTS: The mean (range) follow-up was 3.9 (0.5-6) years; the neophallus was 5.7 (4-10) cm, considered satisfactory in 17 patients but the remaining five required additional phalloplasty. The complications were urethral stenosis in two and fistula in three patients. CONCLUSIONS: Metoidioplasty is an alternative to phalloplasty, allowing voiding while standing. In patients who desire a larger phallus, various techniques of phalloplasty can also be used.

Long-term functional outcome of kidneys in children with urolithiasis after ESWL treatment.

The aim of this study was to determine the long-term functional outcome of kidneys in children with urolithiasis treated by means of extracorporeal shock wave lithotripsy (ESWL). The effectiveness and safety of this method in the management of pediatric urinary stone disease was also studied. This prospective study enrolled 84 children, 33 boys (age: 9.1 +/- 3.8 yrs) and 51 girls (age: 9.6 +/- 3.9 yrs), with urolithiasis who were treated using a second-generation "Siemens" Lithostar lithotriptor, in the period between 1988 and 1998. Dynamic kidney scintigraphy using (99 m)Tc-DTPA was done prior to, immediately following ESWL treatment, three months later, and again after an observation period of 12 - 67 months (38 +/- 13 months). Immediate fragmentation rate was 90 %, while the calculus clearance rate was 61 %. Glomerular filtration rate (GFR), measured by clearance of (99 m)Tc-DTPA, immediately after an ESWL treatment of 107 +/- 6 ml/min was significantly lower compared to the pretreatment value of 118 +/- 7 ml/min, but returned three months later to 121 +/- 6 ml/min, and to 131 +/- 10 ml/min at the end of the observation period. A separate analysis was performed on three groups of patients treated by ESWL: with acute calculous disease, chronic calculous disease, and chronic calculous with partial stasis. ESWL treatment in children with acute obstruction was associated with an immediate increase in GFR; however, in chronic calculous disease a decrease in GFR was found. A return of GFR to the pretreatment level was observed at the three-month control in these patients. In patients with acute stone obstruction, at 3 and 12 - 67 months after ESWL treatment, GFR of the treated kidney was found to be significantly increased compared to the pretreatment level. In contrast, in children with chronic calculous disease this increase was modest. This study has demonstrated ESWL to be an effective treatment option for urinary calculi management, which can be safely performed in a pediatric population without long-term effects on the growing kidneys.

Identification of highly conserved genes: SNZ and SNO in the marine sponge Suberites domuncula: their gene structure and promoter activity in mammalian cells(1).

Recently, we reported that cells from the sponge Suberites domuncula respond to ethylene with an increase in intracellular Ca(2+) level [Ca(2+)](i), and with an upregulation of the expression of (at least) two genes, a Ca(2+)/calmodulin-dependent protein kinase and the potential ethylene-responsive gene, termed SDSNZERR (A. Krasko, H.C. Schröder, S. Perovic, R. Steffen, M. Kruse, W. Reichert, I.M. Müller, W.E.G. Müller, J. Biol. Chem. 274 (1999)). Here, we describe for the first time that also mammalian (3T3) cells respond to ethylene, generated by ethephon, with an immediate and transient, strong increase in [Ca(2+)](i). Next, the promoter for the sponge SDSNZERR gene was isolated from S. domuncula. It was found that the SDSNZERR gene is positioned adjacent to the SNZ-related gene (SNZ-proximal open reading frame) (SDSNO) and linked, as in Saccharomyces cerevisiae, in a head-to-head manner. Until now, neither homologues nor orthologues of these two genes have been identified in higher metazoan phyla. The full-length genes share a bidirectional promoter. 3T3 cells were transfected with this promoter; the activity of the SDSNZERR promoter was strong and twice as high as that of the SV40 promoter, while the SDSNO promoter was less active. Surprisingly, the activity of the SDSNZERR promoter could not be modulated by ethylene or salicylic acid while it is strongly upregulated, by 4-fold, under serum-starved conditions. It is concluded that the modulation of the level of [Ca(2+)](i) by ethylene in mammalian cells is not correlated with an upregulation of the ethylene-responsive gene SDSNZERR. The data indicate that in mammalian cells, the activity of the SDSNZERR promoter is associated with the repression of serum-mediated growth arrest.

[Creation of a new vagina using a part of the rectosigmoid colon]. / Formiranje nove vagine od dela rektosigmoidnog kolona.

The paper shows the indications, preoperative and intraoperative evaluation as well as the way to make a new vagina. The authors advise to use part of colon sigmoideum to make a new vagina, this vagina is very much like the real one and the function is unlimited. During the operation the shortest possible part of colon sigmoideum should be taken in order to avoid oversecretion (mucorrhoea). After taking the segment and making termino-terminal anastomosis the tunnel should be made between the bladder and rectum and the segment should be stitched to the introitus of the vagina. For three weeks after the operation the patient should keep a tampon in the [figures: see text] new vagina and we suggest the dilatation of the introitus for three months. After the three months period we advise the sexual intercourse. The number of postoperative complications was minimal and the sexual intercourse was normal.

Modulation of intracellular calcium and proliferative activity of invertebrate and vertebrate cells by ethylene.

BACKGROUND: Ethylene is a widely distributed alkene product which is formed enzymatically (e.g., in plants) or by photochemical reactions (e.g., in the upper oceanic layers from dissolved organic carbon). This gaseous compound was recently found to induce in cells from the marine sponge Suberites domuncula, an increase in intracellular Ca2+ level ([Ca2+]i) and an upregulation of the expression of two genes, the potential ethylene-responsive gene, SDERR, and a Ca2+/calmodulin-dependent protein kinase. RESULTS: Here we describe for the first time, that besides sponge cells, mammalian cell lines (mouse NIH-3T3 and human HeLa and SaOS-2 cells) respond to ethylene, generated by ethephon, with an immediate and strong, transient increase in [Ca2+]i level, as demonstrated using Fura-2 imaging method. A rise of [Ca2+]i level was also found following exposure to ethylene gas of cells kept under pressure (SaOS-2 cells). The upregulation of [Ca2+]i was associated with an increase in the level of the cell cycle-associated Ki-67 antigen. In addition, we show that the effect of ethephon addition to S. domuncula cells depends on the presence of calcium in the extracellular milieu. CONCLUSION: The results presented in this paper indicate that ethylene, previously known to act as a mediator (hormone) in plants only, deserves also attention as a potential signaling molecule in higher vertebrates. Further studies are necessary to clarify the specificity and physiological significance of the effects induced by ethylene in mammalian cells.

[Fixation of the vagina and neovagina with the sacrospinal ligament]. / Fiksacija vagine i neovagine za sakrospinalni ligament.

In order to fix the prolapse of vaginal vault after vaginal or abdominal hysterectomy we use the technique of transvaginal sacrospinous colpopexy. The authors used this technique for the firs time when they have made neovagina at male transsexual. The technique is as follows: after making the tunnel between the bladder and recrum, under the control of the left hand fingers the vagina, or neovagina is fixed to sacrospinous ligament. No complications or recidive followed the operation ever. The authors point out that the skillfull surgeon should know very well the anatomy of both male or female pelvis in order to perform this operation.

The penile disassembly technique in the surgical treatment of Peyronie's disease.

OBJECTIVE: To present an approach for treating Peyronie's disease, using the penile disassembly technique for reconstructive surgery. PATIENTS AND METHODS: From November 1996 to September 2000, 74 patients with Peyronie's disease were treated surgically. The penile disassembly technique was used in 46 of the patients (mean age 51 years, range 21-63). The indications were severe penile deviation under the glans cap, plaque in the distal third of the corpora cavernosa with the 'hour-glass' phenomenon, and more than one plaque at different sites. The corporal bodies are separated from the glans, neurovascular bundle and urethra. The technique enables the complete preservation of all structures of the neurovascular bundle, especially if it is incorporated into the plaque. The method provides an excellent approach to the repair of all deformities on the completely free corpora cavernosa and that are affected by the plaque. In the plaque region, incisional grafts are placed using full-thickness penile skin or saphenous vein. The technique also enables reduction corporoplasty, i.e. amputation of the tips of the corpora cavernosa that include plaque, in those with sufficient penile length. Penile re-assembly involves joining the glans, neurovascular bundle, urethra and repaired corpora cavernosa into their normal anatomical relationships. RESULTS: The mean (range) follow-up was 27 (6-53) months. The penis was completely straightened in 40 patients (87%) but the deviation recurred in six. In four patients the deformity was <10 degrees and in two was <20 degrees. Penile shortening occurred in 9% of the patients. There was no evidence of inflammation or infection after surgery. There were no injuries of either the neurovascular bundle or urethra. CONCLUSION: The penile disassembly technique could be a good alternative to other surgical techniques in treating selected patients with Peyronie's disease; it allows an excellent approach to penile deformities which can then be easily and safely corrected.

Penile lengthening.

OBJECTIVE: To describe a technique for penile lengthening and the results achieved. PATIENTS AND METHODS: The penis is completely disassembled into its anatomical parts; the glans cap remains attached dorsally to the neurovascular bundle and ventrally to the urethra and corporal bodies. A space is created between glans cap and the tip of corpora cavernosa; this space is used to insert autologous cartilage previously harvested from the rib, the space being measured beforehand when the corpora cavernosa are erect. The anatomical entities and inserted cartilage are joined together to form a longer penis. The increased length of the penis depends directly on the elasticity of the urethra and especially of the neurovascular bundle. From June 1995 to March 1999 the technique was applied in 19 patients aged 18-52 years, who were followed for a mean (range) of 3.3 (1-4.5) years. RESULTS: The increase in penile length was moderate, at 2-4 cm; there were no injuries of the neurovascular bundle or urethra, and no erectile dysfunction. Fifteen patients reported painless sexual intercourse, the remaining four patients providing no data. During the follow-up the cartilage insert remained at about the same size as that at initial implantation. CONCLUSION: The penile disassembly technique combined with the interposition of rib cartilage in the space between the glans cap and tips of the corpora cavernosa provides a genuine increase in penile length, with satisfactory results.

Vaginoplasty in male transsexuals using penile skin and a urethral flap.

OBJECTIVES: To describe and present the results of a one-stage vaginoplasty in male-to-female sex reassignment surgery. PATIENTS AND METHODS: The present technique is based on penile disassembly and the use of all penile components for vaginoplasty (except the corpora cavernosa). The neovagina consists of two parts; a long vascularized urethral flap and a pedicled island tube skin flap created from the penile skin. The urethral flap is embedded into the skin tube. The tube, consisting of skin and the urethral flap, is inverted, thus forming the neovagina. The new vagina is inserted into the previously prepared perineal cavity between the urethra, bladder and rectum. The neovagina is then fixed to the sacrospinous ligament. The labia minora and majora are formed from remaining penile and scrotal skin. The new method was used in 89 patients (mean age 28 years, range 18-56) with a mean (range) follow-up of 4. 6 (0.25-6) years. RESULTS: Good cosmetic and functional results were obtained in 77 of the 89 patients (87%). Importantly, the neovagina produced in most patients was of satisfactory depth and width. There was only one major complication, a rectovaginal fistula caused by intraoperative injury to the rectum. CONCLUSIONS: The technique produces a vagina with more normal anatomical and physiological characteristics than those produced by other methods, as all the penile components are used (except for the corpora cavernosa) to form almost normal external female genitalia. Vaginoplasty using pedicled penile skin with a urethral flap is a good alternative to other methods of vaginoplasty in male-to-female sex reassignment surgery.

Augmentation ureterocystoplasty could be performed more frequently.

PURPOSE: Megaureter represents the ideal tissue for bladder augmentation but to date ureterocystoplasty has been used only in select cases. We demonstrate that ureterocystoplasty can be used more frequently by dividing the megaureter and using its distal part for bladder augmentation and proximal part for reimplantation into the bladder. This technique can be performed as a 1 or 2-stage procedure. MATERIALS AND METHODS: From November 1995 to October 1998 ureterocystoplasty was performed in 16 patients 3 to 12 years old (mean age 6.6). In 9 cases with impaired renal function loop cutaneous ureterostomy had been previously done to preserve and improve renal function. In the remaining 7 cases bladder augmentation and simultaneous ureteroneocystostomy were performed without cutaneous ureterostomy. Ureterocystoplasty was done extraperitoneally. This distal part of megaureter was used for bladder augmentation and the proximal part was implanted into the bladder using extravesical detrusor tunneling ureteroneocystostomy in a majority of cases. RESULTS: Followup ranged from 12 months to 4 years (mean 2.8). The new increased bladder capacity ranged 296 to 442 ml. (mean 371) in both groups. Compliance was improved in all cases with a decrease in the number of clean intermittent catheterizations daily, and there was no further worsening of renal function. Vesicoureteral reflux was noted in 3 patients without clinical symptoms. CONCLUSIONS: Megaureter presents the ideal tissue for bladder augmentation. Division of the ureter and use of its distal part for augmentation is always possible. Augmentation ureterocystoplasty performed this way can be done more frequently.

Dinoflagellates from marine algal blooms produce neurotoxic compounds: effects on free calcium levels in neuronal cells and synaptosomes.

In this report, evidence is presented that the marine unicellular eukaryotic dinoflagellates can cause neurotoxicity very likely by an increase in intracellular free calcium ions ([Ca(2+)](i)). Determinations of the effects of culture supernatants from different clones of the dinoflagellate Alexandrium sp. isolated from algal blooms on the viability of rat primary neuronal cells revealed that all clones tested were toxic for these cells. In addition, all Alexandrium clones tested, except for A. ostenfeldii BAH ME-141, were found to be toxic for rat pheochromocytoma PC12 cells. No toxicity was observed for culture supernatants from Gonyaulax and Coolia monotis. Calcium ions are important in the process of apoptotic cell death; our studies revealed that the dinoflagellate supernatants from A. lusitanicum K2, A. lusitanicum BAH ME-091, and A. tamarense 1M caused an increase in [Ca(2+)](i) levels in both PC12 cells and primary neuronal cells. These dinoflagellate supernatants, as well as the A. tamarense ccmp 115 supernatant, were found to cause also an increase in free calcium concentration in isolated synaptosomes. Our results suggest that the neurotoxic effects of certain dinoflagellate supernatants may be associated with disturbances in [Ca(2+)](i) levels.

Ethylene modulates gene expression in cells of the marine sponge Suberites domuncula and reduces the degree of apoptosis.

Sponges (phylum Porifera) live in an aqueous milieu that contains dissolved organic carbon. This is degraded photochemically by ultraviolet radiation to alkenes, particularly to ethylene. This study demonstrates that sponge cells (here the demosponge Suberites domuncula has been used), which have assembled to primmorphs, react to 5 microM ethylene with a significant up-regulation of intracellular Ca(2+) concentration and with a reduction of starvation-induced apoptosis. In primmorphs from S. domuncula the expression of two genes is up-regulated after exposure to ethylene. The cDNA of the first gene (SDERR) isolated from S. domuncula encodes a potential ethylene-responsive protein, termed ERR_SUBDO; its putative M(r) is 32,704. Data bank search revealed that the sponge polypeptide shares high similarity (82% on amino acid level) with the corresponding plant molecule, the ethylene-inducible protein from Hevea brasiliensis. Until now no other metazoan ethylene-responsive proteins have been identified. The second gene, whose expression is up-regulated in response to ethylene is a Ca(2+)/calmodulin-dependent protein kinase II. Its cDNA, SDCCdPK, encodes a M(r) 54,863 putative kinase that shares 69% similarity with the corresponding enzyme from Drosophila melanogaster. The expression of both genes in primmorphs from S. domuncula is increased by approximately 5-fold after a 3-day incubation period with ethylene. It is concluded that also metazoan cells, with sponge cells as a model, may react to ethylene with an activation of cell metabolism including gene induction.