Optimal conditions to induce rat adrenal medullary changes, such as pheochromocytoma, by nicotine.

BACKGROUND: Nicotine-induced adrenal medullary hypertrophy in rats has been suggested to be a model for pheochromocytoma. Study conditions for proving such an assertion, however, have not been optimized. METHODS: Studies on strain difference, dose dependency, and the time course of catecholamine metabolism in response to nicotine treatment were conducted. Under the putative optimal experimental conditions, metabolic and histologic changes in the adrenal medulla were investigated. RESULTS: Male Wistar rats treated with a maximum dose of 4 mg/kg per day of nicotine for 9 weeks, including a 2-week lead-in period, developed highly consistent changes in the adrenal medulla. Concerning metabolic indices, the norepinephrine content of the adrenal and the urinary excretion of epinephrine and metanephrine were significantly elevated. Hyperplastic and hyperactive states of the adrenal medulla were also indicated by a morphometric analysis on electron microscopic figures. These showed an enlarged cytoplasmic area, the development of a rough-surfaced endoplasmic reticulum, and an increased number and density of intracellular catecholamine granules. The metabolic changes were found to reverse 3 weeks after the cessation of nicotine administration. CONCLUSION: These results provide better-defined experimental conditions for an animal model of pheochromocytoma.

[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.

[The effect of extracorporeal shock wave lithotripsy on kidney and adjacent tissue detected by magnetic resonance imaging].

Extracorporeal shock wave lithotripsy (ESWL) using YACHIYODA SZI was performed on 12 patients with renal stones and the effect on the kidney and adjacent tissue was evaluated by magnetic resonance imaging (MRI) before and after treatment. Some changes were seen in 6 of the 12(50%) patients; perirenal fluid collection in 2 of the 12 (16.7%) patients, subcapsular hematoma in 2 of the 12 (16.7%) patients, renal enlargement in 5 of the 12 (31.3%) patients, increased signal intensity in perirenal tissue in 6 of the 12 (50%) patients, and loss of the corticomedullary junction 2 out of 9 patients (22%). These findings indicated fewer changes in the kidney after ESWL using YACHIYODA SZI than in the other reports. MRI is also concluded to be effective to detect the changes of the kidney after ESWL.

[Transurethral radiofrequency thermotherapy for benign prostatic hyperplasia].

Transurethral radiofrequency thermotherapy was performed in 38 patients with benign prostatic hyperplasia using Thermex II (Direx) between December 1992 and June 1993, and its clinical efficacy was evaluated by analysing the subjective and objective responses following the treatment. Each patient was treated with an indwelling 16 Fr balloon catheter with electrode, in a single session of 90 minutes at 47-47.5 degrees C. The clinical efficiency was evaluated by total of AUA symptom score and objective findings in terms of maximum flow rate 12 weeks after treatment. The symptom score improved from 15.4 +/- 4.9 (mean +/- SD) to 7.3 +/- 5.2 25% or more improvement was found in 80% (20/25) of patients. No significant change was found in average of maximum flow rate before and after treatment, which were 8.9 +/- 4.1 (ml/sec) and 9.2 +/- 3.3, respectively. During the treatment no severe adverse effect except sense of heat and urgency was detected. Posttreatment urinary retension was found in 9 patients and catheters were indwelled in eight of them for a few days and prostatectomy was performed in one patients after 8 weeks of treatment. In four patients prostatectomy was performed between one day and 8 weeks after thermotherapy and histrogical effect on the resected specimen was examined. In the prostatic urethra, hemorrhage and inflammatory change were observed. However, in the prostatic tissue there was no necrotic region. Transurethral radiofrequency thermotherapy is safe and easy and it may be one of the useful treatments for benign prostatic hyperplasia.

[Experience with YACHIYODA SZ-5000 extracorporeal shock wave lithotripsy].

YACHIYODA SZ-5000 is a new model of lithotriptor made in Japan, of which the energy source is microexplosion. Compared with the old type of SZ-1, the water bag is substituted for a hot water bath and ultrasonography as well as fluoroscopy can be used for stone localization. Moreover, this new model is extremely small. The first clinical trial of 32 candidates with urinary tract calculi (34 stones) was performed at our hospital between September 1991 and June 1992. They were 10 women and 22 men between 25 and 71 with a mean of 47.3 years. All patients received no anesthesia. The stone location was: R2 for 16 stones, R3 for 5, U1 for 9, U2 for 1, and U3 for 3. The mean size was 14.1 mm. A mean number of 364, 326 and 324 shock waves were given for the R2, 3, U1, and U2, 3 stones, respectively. The second or third sessions were performed on 7 patients. Obvious symptoms and signs observed during the treatment were; local pain in 9 patients, nausea in 3, hypotension and bradycardia in 6, and hypertension in 3. Posttreatment fever up was found in two patients. In 34 stones, the efficiency evaluated 3 months later was 85.0% as determined by kidney-ureter-bladder X-ray and intravenous pyeography. In conclusion, YACHIYODA SZ-5000 is useful and safe in the management of patients with urinary tract stones.

[A survey of postoperative steroid replacement in 40 patients with Cushing's syndrome].

Adrenalectomy for Cushing's syndrome due to adrenocortical adenoma was performed on 40 patients at Tokyo University Hospital between 1960 and 1990. There were 32 women and 8 men aged 2 to 59 (mean 35.7) years. Three different operative approaches to the adrenal gland were employed: lumbar approach in 24 cases, dorsal in 8, and transabdominal in 8 of whom 7 patients were operated before 1970 without definite preoperative localization of the lesions. Postoperative administration of cortisone and hydrocortisone as a steroid replacement has been reduced in duration and dosage in recent 10 years. Average treatment period was 3 years and 1 month in the 1970's, and 9.5 months in the 1980's, respectively. The mean daily dosage of steroid hormone was 517.5 mg (mean) on the operative day and 43.1 mg after three weeks in the 1970's, while 187.5 mg and 18.4 mg in the recent five years, respectively. Nonetheless, even in the recent 6 patients, metabolic alkalosis and hypopotassemia because of steroid excess were observed in a few days after the surgery. These observations indicate that period and dosage of steroid replacement have been reduced in these years and could be further shortened by means of rapid tapering in the early postoperative phase.

Penetration of cefpirome into renal and prostatic tissue.

We have conducted a study on the antibacterial activity and penetration into prostatic and renal tissue of cefpirome (CPO), a new injectable cephalosporin drug, and have obtained the following results. In the target bacterium Neisseria gonorrhoeae stored in this Department (34 non-PPNG isolates, 20 PPNG isolates), the minimum inhibitory concentration (MIC) distribution of CPO was < or = 0.003-0.1 micrograms/ml for the non-PPNG isolates and 0.006-0.1 micrograms/ml for the PPNG (penicillinase-producing Neisseria gonorrhoeae) strains, with MIC90 values of 0.1 microgram/ml and 0.05 microgram/ml respectively. Concentrations in blood and in prostatic tissue were measured in 30 prostatectomy patients after intravenous injections of 1 g of CPO. The concentration in prostatic tissue reached a maximum of 52.9 micrograms/g 15 min after administration, and gradually decreased thereafter, with average values of 17.9 micrograms/g at 60 min, 10.3 micrograms/g at 180 min, 7.22 micrograms/g at 320 min (one patient) and 2.70 micrograms/g at 360 min (one patient). There was a positive correlation between prostatic tissue concentration and blood concentration at the time of tissue collection, and it is considered that CPO penetrated into the prostatic tissue to an extent dependent on its concentration in the blood. In renal tissue, measured in 4 nephrectomy patients, the CPO concentrations found were 107-148 micrograms/g in the cortex and 80.6-88.6 micrograms/g in the medulla, which were higher than the blood concentration levels in all of the subjects. These findings indicate that CPO showed sufficient concentrations in the blood and tissues for it to be considered highly useful in the treatment of urological infections.

[Acute nongonococcal epididymitis--pharmacological and therapeutic aspects of levofloxacin].

We performed basic and clinical studies on the effects of a new oral quinolone derivative, levofloxacin (LVFX, Code No. DR 3355) which is an optical l-isomer of ofloxacin, in acute epididymitis. LVFX was administered in a dose of 200 mg to prostatic cancer patients 2 hours before operation. The mean concentration of LVFX in the tissues of testis and epididymis were 4.73 micrograms/g and 313-3.6 micrograms/g, respectively. Tissue/Serum ratios were 1.63 and 1.16-1.32, respectively. LVFX was administered in a dose of 100 mg three times daily for 13 days to healthy male volunteers. Semen and blood samples were taken 2 hrs after 7th and last day of administration. The concentration of LVFX in semen were 1.19 micrograms/ml (7th day) and 1.32 micrograms/ml (13th day). Semen/serum ratios were 1.12 and 1.26, respectively. No affection of LVFX on the sperm was observed. Antimicrobial activity of LVFX to C. trachomatis showed good MICs of 0.25-1.0 micrograms/ml. LVFX was administered in a dose of 100 mg two or three times daily for 14 days to 23 patients with acute epididymitis. The overall efficacy rate based on a criteria for acute epididymitis showed 100% (excellent: 16, good: 4, 20/20). A better efficacy rate was obtained on the 14th day than 7th day. No subjective or objective adverse reactions were observed.

[Bacteriological and clinical studies on levofloxacin in male gonococcal urethritis].

We performed basic and clinical studies in male gonococcal urethritis on a new oral antimicrobial agent, levofloxacin (LVFX, DR-3355), a new quinolone derivative. The antibacterial activity of LVFX against clinical strains of Neisseria gonorrhoeae was roughly comparable to that of ofloxacin, and ciprofloxacin. LVFX was administered to 10 males with gonococcal urethritis, 200 mg twice a day (8 cases) or 100 mg twice a day for 3 days (2 cases). Clinical evaluation was made according to the criteria of the Japanese UTI Committee. Overall efficacy rate was 100% (10/10). In the complication of chlamydia trachomatis (2 cases), efficacy rate was 100% (2/2). No subjective or objective adverse reactions occurred.

[Giant seminoma of the left testis: a case report].

A 66-year-old man visited our hospital with a history of a slowly growing left scrotal contents for the past 5 years. Serum beta-human chorionic gonadotropin and lactate dehydrogenase was greatly elevated. The resected mass was 26 cm x 16 cm x 13 cm in size, 2,258 g in weight. It arose from left testis and grew to the left inguinal region. Histologically it was pure seminoma.

[A basic study on cefpirome].

The antibacterial activity of cefpirome (CPR), a new parenteral cephalosporin antibiotic having a cyclopentenopyridine group in the 3-position side chain, was evaluated against Neisseria gonorrhoeae and concentrations in human kidney and prostate was determined. The minimum inhibitory concentrations (MICs) of CPR against N. gonorrhoeae isolated clinically in our out-clinic (34 strains of non-PPNG and 20 of PPNG) were less than or equal to 0.003-0.1 microgram/ml in non-PPNG group and 0.006-0.1 microgram/ml in PPNG group. The 90% of MICs (MIC90s) was 0.1 microgram/ml in the non-PPNG group and 0.05 microgram/ml in the PPNG group. The concentration in the prostate was determined in 30 cases with benign prostatic hypertrophy. The maximum values was 52.8 micrograms/g at 15 minutes after administration of 1 g of CPR. The levels of CPR were gradually decreased with the lapse of time. The prostatic tissue concentration was 17.9 micrograms/g at 60 min., 10.1 micrograms/g at 180 min., 7.22 micrograms/g at 320 min. and 2.70 micrograms/g at 360 min. There was a positive correlation between concentration of the prostate and plasma collected at the time of the prostate. The concentration of CPR in human kidney, 90-100 min. after administration of 1 g to 4 cases with renal tumor, was 107-148 micrograms/g in the renal cortex, and 80.6-88.6 micrograms/g in the renal medulla. The concentration in kidney was higher than that in the plasma in all cases. In conclusion, CPR is suggested to be a useful drug for urological infection.