Id proteins in cell growth and tumorigenesis.

Since the gene encoding Id1 was cloned in 1990, Id proteins have been implicated in regulating a variety of cellular processes, including cellular growth, senescence, differentiation, apoptosis, angiogenesis, and neoplastic transformation. The development of knockout and transgenic animal models for many members of the Id gene family has been particularly useful in sorting out the biologic relevance of these genes and their expression during normal development, malignant transformation, and tumor progression. Here we review the current understanding of Id gene function, the biologic consequences of Id gene expression, and the implications for Id gene regulation of cell growth and tumorigenesis.

Id1 regulates angiogenesis through transcriptional repression of thrombospondin-1.

Id proteins are helix-loop-helix transcription factors that regulate tumor angiogenesis. In order to identify downstream effectors of Id1 involved in the regulation of angiogenesis, we performed PCR-select subtractive hybridization on wild-type and Id1 knockout mouse embryo fibroblasts (MEFs). Here we demonstrate that thrombospondin-1 (TSP-1), a potent inhibitor of angiogenesis, is a target of transcriptional repression by Id1. We also show that Id1-null MEFs secrete an inhibitor of endothelial cell migration, which is completely inactivated by depletion of TSP-1. Furthermore, in vivo studies revealed decreased neovascularization in matrigel assays in Id1-null mice compared to their wild-type littermates. This decrease was completely reversed by a TSP-1 neutralizing antibody. We conclude that TSP-1 is a major target for Id1 effects on angiogenesis.

The rectal tube: an excellent catheter for severe clot retention.

PURPOSE: We describe the use of an alternative catheter for clot irrigation. MATERIALS AND METHODS: Six patients with severe clot retention that could not be treated successfully with irrigation using large bore urethral catheters were subsequently treated with a fenestrated 28 to 32F Rusch red rubber rectal catheter. RESULTS: All clots were successfully evacuated. Cystoscopic evaluation the following day in 4 patients with hematuria confirmed the absence of clots. The other 2 patients did not undergo cystoscopy but continuous bladder irrigation was completely clear for the next 24 hours and the catheters were removed without further sequelae. CONCLUSIONS: Irrigation through a rectal tube can provide immediate relief of clot retention and consequently avoid emergency endoscopic intervention in the operating room.

Antegrade ejaculation following transurethral laser ablation of the prostate.

A major drawback for many sexually active men who undergo a prostatectomy for benign prostatic hyperplasia, either via a transurethral resection or an open procedure, is the high incidence of retrograde ejaculation. Transurethral laser ablation of the prostate (TULAP) is a minimally invasive alternative to these procedures for prostatic outlet obstruction. We retrospectively reviewed 37 patients who underwent the TULAP procedure. Our data revealed that in addition to a significant improvement in voiding symptoms, 92% of sexually active patients retained both potency and antegrade ejaculation postoperatively. We conclude that this procedure is a viable alternative to transurethral prostatectomy, especially for the men who wish to remain sexually potent with antegrade ejaculation. A rationale for the mechanism of preservation of ejaculatory function is discussed.

Andrological implications of visual laser ablation of prostate (VLAP).

300 VLAP procedures are reported with no mortality and very little morbidity. The results are comparable to TURP with lower incidence of impotence, preservation of ejaculation, little blood loss, less chance of scarring and higher acceptance of the public undergo a laser procedure.

A lethal complication of papaverine-induced priapism.

A large series of patients was treated for impotence with intracorporeal injections of papaverine and phentolamine with no major complications and no deaths reported. We report on a 45-year-old black man with advanced multiple sclerosis who died after such therapy. When the first self-administered injection of phentolamine and papaverine failed to produce an adequate erection the patient injected a second dose that resulted in priapism and death of massive pulmonary embolism.

Severe hemorrhage secondary to primary, isolated in situ carcinoma of renal pelvis.

Primary transitional cell carcinoma in situ of the renal pelvis is usually found in association with ureteral or vesical neoplasms. However, a case of primary carcinoma in situ of the renal pelvis without previous or concomitant ureteral or vesical carcinoma is presented. Microscopic hematuria is a common finding in cases of carcinoma in situ. Gross hematuria is unusual, but not rare. However, severe hemorrhage (hematocrit 12.1, hemoglobin 3.3 g/dL) as the presenting feature is rare. Diagnosis of such microscopic isolated lesions can be difficult to make pre-operatively. Only after nephrectomy will such a lesion be diagnosed, as was the case in this patient.

99mTc penile scan: an investigative modality in priapism.

A 99mTc penile scan was performed in 9 patients with priapism. The technique of the procedure is described. Penile scan is an easily obtainable modality that can differentiate between high- and low-flow forms of priapism. We believe that these scintigraphic findings facilitate management of priapism.