Spontaneous rupture of the ureter after cystectomy and creation of orthotopic ileal neobladder: treatment with percutaneous nephrostomy and drainage.

A case of rupture of the upper ureter following creation of a continent orthotopic neobladder, treated conservatively with percutaneous nephrostomy and drainage of a paranephric collection, is reported.

Biopsies of the transitional zone of the prostate. Should it be done on a routine basis, when and why?

PURPOSE: In this prospective study we try to evaluate the necessity of performing additional transitional zone biopsies as part of the standard sextant biopsies procedure in order to detect prostate cancer. MATERIALS AND METHODS: During a 12-month period we performed biopsies in 420 patients. All patients had two additional biopsies of the transitional zone biopsies. 289 of them were biopsies for the first time because they had an elevated PSA and/or a suspicious DRE. One hundred and thirty-one had a repeat biopsy because of the remaining elevated PSA after the previous negative one. RESULTS: Of the 420 patients 143 (34%) had cancer, with 11 (7%) having cancer in the transitional zone only. Patients initially evaluated because of high PSA and or a positive DRE had only 2 (2.1%) cancers exclusively in the transitional zone. We found that this percentage rises (18.7%) when the patients had already at least one previous negative biopsy of the peripheral zone, and during the repeat biopsy the transitional zone is samples. CONCLUSIONS: The low yield of transitional zone biopsies (2.1%) during first time sampling of the prostate does not warrant their systematic use for the early detection of prostate cancer. Instead the effectiveness of biopsies in that area is higher when the biopsy is repeated after an initial previous negative biopsy of the peripheral zone.

Modified ileal neobladder for continent urinary diversion: experience and results.

OBJECTIVES: To describe the surgical technique we currently use for the construction of an orthotopic ileal neobladder. We report our experience and functional results of the first 35 cases. METHODS: Since 1993, 35 men have been treated with an ileal neobladder substitute after cystoprostatectomy for bladder cancer. According to the technique we call "a modified S-ileal neobladder," we place emphasis, first, on the complete detubularization of a smaller segment of bowel and its folding in an S configuration without creating a nipple mechanism, and second, on an oblique intramural ureteral reimplantation. RESULTS: The mean postoperative observation time was 38.2 months (range 6 to 72). No perioperative or early postoperative mortality was observed, and few serious early complications have occurred. Late complications included local tumor recurrence and distant metastases in 1 patient (2.8%) and a vesicoileal fistula requiring surgical correction in 1 patient (2.8%). As of February 2000, a total of 29 patients (82.8%) were emptying their neobladder by relaxation of the urethral sphincter mechanism and/or passive expression of the neobladder by abdominal straining. Six patients (17.1%) required clean intermittent catheterization. Daytime continence was attained in 31 patients (88.5%) and nocturnal incontinence was noted in 9 (26%). CONCLUSIONS: Several techniques may be used to create an ileal neobladder. A neobladder constructed using a smaller part of ileum that has been completely detubularized and folded in an S configuration without a nipple is easy to perform, has acceptable complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates.

Attempts to induce resistance in mice to Schistosoma japonicum and Schistosoma mansoni by exposure to crude schistosome antigens plus cloned glutathione-S-transferases.

Several attempts have been made to induce resistance in mice to Schistosoma japonicum (Philippines) or Schistosoma mansoni by exposure to living male and/or female adult worms, their antigens or irradiated cercariae. No resistance was demonstrated in the following cases: re-exposure of mice to cercariae following praziquantel (PZQ) treatment of existing infection; re-exposure of mice following cyclosporin A (CsA) treatment at the time of first cercarial exposure; subcutaneous or intraperitoneal deposition of living male or female worms; repeated intranasal administration of crude worm homogenates plus Bordetella pertussis vaccine (BPV) as adjuvant. Homologous 60Co-irradiated cercariae were very effective at inducing resistance to infection with S. mansoni but not to infection with S. japonicum (Philippines) in a limited series of experiments. A regime of infection, immunization with homologous Escherichia coli-derived glutathione-S-transferases (GST), then PZQ treatment followed by homologous re-exposure did not result in significant resistance in either the S. mansoni or the S. japonicum (Philippines) systems. Mice given irradiated cercariae plus GST were not more resistant to subsequent S. mansoni infection than mice given irradiated cercariae alone. The results generally confirm and extend those reported by others with the conclusion that resistance to schistosomes in mice is difficult to achieve by exposure to adult worm antigens alone. Moreover, additional immunization with the GST available to date as cloned gene products, and injected in Freund's complete adjuvant, does not influence the outcome of exposure to crude worm antigens including any additive effects of protective irradiated cercariae.

Structure of the Escherichia coli K12 regulatory gene tyrR. Nucleotide sequence and sites of initiation of transcription and translation.

The nucleotide sequence of 1964 base pairs of the Escherichia coli K12 chromosome containing the autogenously regulated regulatory gene tyrR has been determined. The site of initiation of transcription of tyrR has been mapped by primer-extension analysis, and the initiation codon has been identified by site-specific deletion mutagenesis. The nucleotide sequence predicts a subunit molecular weight of 53,099 for the TyrR protein. Codon usage in the tyrR structural gene shows a bias toward those synonymic codons which are used rarely in efficiently expressed E. coli genes. The nucleotide sequence of a 22-base pair region adjacent to the promoter and distal to the structural gene exhibits considerable identity with corresponding regions of other genes regulated by tyrR. It is proposed that this is a site for repression by the TyrR protein.