[Development of an automated processing method to detect coronary motion for coronary magnetic resonance angiography].

PURPOSE: On coronary MR angiography (CMRA), cardiac motions worsen the image quality. To improve the image quality, detection of cardiac especially for individual coronary motion is very important. Usually, scan delay and duration were determined manually by the operator. We developed a new evaluation method to calculate static time of individual coronary artery. METHODS AND MATERIALS: At first, coronary cine MRI was taken at the level of about 3 cm below the aortic valve (80 images/R-R). Chronological change of the signals were evaluated with Fourier transformation of each pixel of the images were done. Noise reduction with subtraction process and extraction process were done. To extract higher motion such as coronary arteries, morphological filter process and labeling process were added. Using these imaging processes, individual coronary motion was extracted and individual coronary static time was calculated automatically. We compared the images with ordinary manual method and new automated method in 10 healthy volunteers. RESULTS: Coronary static times were calculated with our method. Calculated coronary static time was shorter than that of ordinary manual method. And scan time became about 10% longer than that of ordinary method. Image qualities were improved in our method. CONCLUSION: Our automated detection method for coronary static time with chronological Fourier transformation has a potential to improve the image quality of CMRA and easy processing.

Property of metallothionein as a Zn pool differs depending on the induced condition of metallothionein.

Metallothionein (MT) is a low-molecular-weight, cysteine-rich, heavy metal-binding protein with several putative physiological functions as a radical scavenger and a regulator of metabolism of Zn. Although the induction of hepatic MT by a wide range of stressors is a well-known phenomenon, little is known about the role of MT in stressful situations. Since MT regulates Zn metabolism, we investigated the differences between affinities of MT for Zn in various stressful conditions in this study. Divalent cadmium ions are capable of displacement of Zn from MT in vitro. Therefore, we assayed the binding of Zn to MT induced by various stimuli using in vivo administration of Cd. MT was induced by paraquat (PQ), a reactive oxygen generator, fasting stress and restraint stress. Apo-MT induced by them bound to Zn in vivo. Zn, which bound to MT induced by PQ, was displaced by the administration of Cd. However, Zn that had bound to MT induced by fasting stress and restraint stress was not displaced by Cd. Moreover, we assessed the in vivo affinity of Zn to MT induced by fasting stress under the condition of subchronic Cd exposure. Cd was administered to mice by subcutaneously implanted Alzet osmotic minipumps, which released constant amounts of Cd over a 14-day period. After 4 days, mice were fasted for 24 h and hepatic MT was examined. Interestingly, it was found that Zn had displaced Cd bound to MT. These findings indicate that the affinity of MT for Zn differs depending on the stimulus by which MT was induced. This is the first report on differences in the properties of MT depending on the stimulus used to induce MT.

Erythrocyte aldose reductase correlates with erectile dysfunction in diabetic patients.

Erectile dysfunction (ED) is a common complication of diabetes mellitus. Erythrocyte aldose reductase (AR) has been implicated in a variety of diabetic complications. The subjects were 62 diabetic patients, of whom 25 were treated with hemodialysis (chronic renal failure CRF group) and the remaining 37 did not have chronic renal failure (DM group). The controls were 20 healthy volunteers age-matched to the patients. The level of AR was measured by the quantitative determination kit for AR in all patients and controls. In this study, ED was diagnosed by 5-item version of the International Index of Erectile Function (IIEF-5). The average level of AR in the CRF group was significantly higher than that in the DM group and controls (P<0.001). The average level of AR in the DM group without ED was significantly lower than that in the DM group with ED and controls (P<0.005). These results suggest that the level of AR may be a useful modality for prediction of ED in diabetic patients.

Significant decrease of the International Index of Erectile Function in male renal failure patients treated with hemodialysis.

In order to evaluate the erectile function in male renal failure patients treated with hemodialysis (HD), we investigated the International Index of Erectile Function (IIEF) in patients and healthy controls. The subjects were 174 male patients treated with HD, of whom 43 had diabetes mellitus (DM) and the remaining 131 patients did not have DM. The controls were 1133 healthy males. We evaluated the prevalence of erectile dysfunction (ED) using the erectile function (EF) score, which is one of the five domains of the IIEF, in each age group (upto 39 y old, 40-49 y old, 50-59 y old, 60-69 y old). The severity of ED was classified into five categories using EF in each age group. The univariate logistic regression analysis and multiple variate analysis of IIEF in HD patients were performed. The prevalence of ED in HD patients was significantly higher than that in the controls in each age group. The severity of ED in HD patients was also significantly higher than that in the controls in each age group. In the logistic regression analysis and multiple variate analysis of IIEF in HD patients, DM and age were significant risk factors on sexual dysfunction. ED was more prevalent in male renal failure patients treated with HD than in the controls. In the patient group, ED was more prevalent in older DM patients.

State dependent response of the locus caeruleus neurons to bladder distention.

PURPOSE: The precise mechanism by which normal persons wake upon urinary sensation is unclear. The locus caeruleus in the pons is suggested to be involved in the activating systems for arousal. We evaluated the effects of bladder distention on the neural activity in the l. caeruleus under different states of anesthesia. MATERIALS AND METHODS: Experiments were performed on 20 male Sprague-Dawley rats. The spontaneous discharge rate of single neurons in and around the l. caeruleus was recorded with the rat under urethane anesthesia administered intraperitoneally, while the electroencephalogram was monitored simultaneously. The changes of the discharge rate of the neurons were observed during saline infusion into the bladder or during tail pinch stimulation. After recording the location of the neurons was confirmed histologically. RESULTS: Of 42 l. coeruleus neurons whose response was examined during deep anesthesia 31 showed an excitatory response to bladder distention, followed by a change in electroencephalogram pattern to a faster and smaller rate, while the remaining 11 showed no response. Of 28 l. coeruleus neurons examined during light anesthesia only 1 neuron was excited and the remaining 27 showed no response. Virtually all of the l. coeruleus neurons unresponsive to bladder distention were responsive to tail pinch stimulation. Of the nonnoradrenergic neurons ventromedial to the l. coeruleus 4 of 7 during deep anesthesia and 5 of 8 during light anesthesia showed an excitatory response to distention. CONCLUSIONS: The excitatory response of the l. coeruleus neurons to bladder distention was strongly affected by the state of anesthesia. The response was observed only during deep anesthesia and was accompanied by lightening of the anesthesia. L. coeruleus may be involved in arousal which is mediated by bladder distention.

Firing of putative cholinergic neurons and micturition center neurons in the rat laterodorsal tegmentum during distention and contraction of urinary bladder.

The relation between unit activity in the laterodorsal tegmental (LDT) area and the state of the urinary bladder was examined in urethane-anesthetized rats. Neurons in the LDT area can be classified into two populations: broad-spike (possibly cholinergic) and brief-spike (non-cholinergic). When the rats showed cortical electroencephalographic activity with large amplitude lower frequency, indicative of deep anesthesia, more than 40% of the broad-spike neurons was excited and about 10% was inhibited by infusion of saline into the bladder. The response was followed by decrease in amplitude and slight increase in frequency of the cortical activity, i.e., lightening of anesthesia. During light anesthesia, excitation was observed only in less than 10% of the units, while 17% was inhibited. In the brief-spike neurons, a similar proportion (about 20%) was excited and less than 10% was inhibited by the distention during either state of anesthesia. About 10% of the broad-spike neurons in the LDT area and 30% of the brief-spike neurons examined were discharged prior to the bladder contraction. Such neurons of the brief-spike category were encountered frequently outside of the central gray; lateral, caudal and ventral to the main mass of cholinergic neurons in the LDT area. These results suggest the possible involvement of the broad-spike (cholinergic) neurons in the elevation of vigilance level caused by bladder distention. The brief-spike (non-cholinergic) neurons firing with relation to bladder contraction may be part of the micturition reflex center.

Systematic treatment for nocturnal urinary frequency following a sleep-micturition chart.

Seven patients complaining of nocturnal urinary frequency were treated following a sleep-micturition chart. By clinical analysis of the data, the causes of nocturnal urinary frequency were divided into three diagnostic categories: a small bladder capacity group, a sleep disorder group and a large nocturnal urinary volume group. The three groups were treated by anticholinergic agents, sleeping pills and restriction of water intake at night respectively. With the administration of anti-cholinergic agents or sleeping pills nocturnal bladder capacity increased. By restriction of water intake at night nocturnal urinary volume decreased. In all patients nocturnal urinary frequency decreased and sleep efficiency was improved.

How does the distention of urinary bladder cause arousal?

Under urethane anesthesia, the urinary bladder of male rats was distended by 0.3-0.5 mL of saline. When the animals displayed large amplitude delta waves, the distention caused tonic excitation in 76% (19/25) of the noradrenergic neurons in the locus coeruleus and in 53% (16/30) of the cholinergic neurons in the laterodorsaltegmental nucleus. The response was followed by a shift of electroencephalogram (EEG) pattern to faster waves of smaller amplitude. When EEG amplitude was faster and smaller, the same stimuli caused no response. Neurons in Barrington's nucleus were excited by a small amount of bladder distention independent of EEG patterns. These results suggest that the transition of state, caused by bladder distention, from deep sleep to light sleep is mediated by noradrenergic and cholinergic neurons in the brainstem.

Relationship between nocturnal urinary frequency and sleep disturbances in aged men.

The relationship between nocturnal urinary frequency and sleep disturbances is investigated in aged men in 12 rural towns in Kyoto and Shiga Prefectures. The subjects were 178 men who did not have diseases or symptoms that were likely to affect urinary condition or sleep. There were no significant differences in sleep disturbances, except sleep maintenance, between the normal group (nocturnal urinary frequency below twice per night) and the abnormal group (nocturnal urinary frequency twice or more per night). In healthy aged men, nocturnal urinary frequency only caused disturbance in sleep maintenance, but did not cause any other sleep disturbance.

Changes in the structure of sleep spindles and delta waves on electroencephalography in patients with nocturnal enuresis.

OBJECTIVE: To evaluate the mechanism of the dysfunction of arousal in patients with Type I and Type IIa enuresis. PATIENTS AND METHODS: The numbers of sleep spindles and delta waves were analysed during electroencephalography in 19 patients with enuresis (17 male, two female, mean age 9.7 years, range 8-14). RESULTS: In four patients with Type I enuresis, who awoke spontaneously and remained dry as a result of urinary sensation, the numbers of sleep spindles and delta waves diminished gradually and finally disappeared just before the patients awoke completely. In the remaining nine patients with Type I enuresis, there was no decrease in the number of sleep spindles and delta waves, and enuresis occurred without the subjects awakening. In the six patients with Type IIa enuresis, there was no arousal reaction or generation of sleep spindles on urination while asleep. CONCLUSIONS: An immaturity in the function of the thalamus might be a cause of the arousal dysfunction in patients with Type I enuresis. In Type IIa enuresis, a possible abnormal or immature arousal mechanism in the pons or the lower tract may be responsible.

The objective assessment of urinary incontinence in children.

OBJECTIVE: To assess urinary incontinence objectively in children. PATIENTS AND METHODS: Thirty-three children (mean age 8.2 years, range 5-12) were examined, of whom 23 suffered from incontinence and 10 did not. The first method of assessing incontinence was the 1-h pad-weighing test proposed by the International Continence Society in 1983 and the second was a test in which the pad was weighed between one urination and the next. At the end of the tests the volume of normally voided urine was measured and the total voided volume during the test calculated. The volume of urine lost during incontinence and the ratio [incontinence volume/(incontinence volume + voided volume)] were evaluated; the ratio was used because the bladder capacity in children differed with age. RESULTS: In both tests, no wetting occurred in any of the 10 patients not complaining of incontinence. In the 1-h pad-weighing test, no wetting occurred in 14 of the 23 patients complaining of incontinence but did in the nine remaining patients, the loss being 1-30 g, and the incontinence ratio 0.5-14.8%. In the second test, no wetting occurred in 12 of the 23 patients complaining of incontinence but did so in the 11 remaining patients, with losses of 2-50 g and incontinence ratios of 1.5-80.6%. CONCLUSIONS: There was no significant difference between the tests in the incidence of incontinence. However, the second method seemed to be more closely related to the clinical symptoms than was the 1-h pad-weighing test and may be useful in the assessment of incontinence in children.

Classification based on overnight simultaneous monitoring by electroencephalography and cystometry.

OBJECTIVES: To evaluate the features of the clinical findings in three types (types I, IIa, IIb) of enuresis, classified by overnight simultaneous monitoring by electroencephalography (EEG) and cystometry (CM). METHODS: We performed a test to evaluate bladder capacity, arousal response and the pattern of nighttime urination in sucklings and infants. RESULTS: As for the values of enuretic bladder capacity (EBC), the smallest were found in enuresis type IIb. As for arousal response, enuresis type I showed the best, while enuresis type IIa showed the worst response. With regard to the pattern of nighttime urination in sucklings and infants, all sucklings had a stable bladder in the sleep state and urinated in the pattern of type IIa. The arousal response to bladder distention indicating type I appeared at the age of about 2 or 3. CONCLUSIONS: The smallest EBC in patients with enuresis type IIb represented a bladder dysfunction in the sleep period. It was observed that patients with enuresis type I had the best arousal function while those with enuresis type IIa had the worst arousal function. All sucklings urinated unconsciously during sleep in the pattern of type IIa. The arousal response to bladder distention indicating type I, which was not observed below the age of 1 year, was thought to appear at the age of about 2 or 3 years. If this change has not appeared by the age of 3, bed-wetting might persist after the age of 5.

Effects of systematic treatment based on overnight simultaneous monitoring of electroencephalography and cystometry.

OBJECTIVE: To clarify the effects of systematic treatment based on overnight simultaneous monitoring by electroencephalography (EEG) and cystometry (CM) on each type of enuresis. METHODS: For enuresis type I, the change in the awakening response during the conditioning treatment with a therapeutic machine was observed. For enuresis type IIa, the effect of imipramine on the EEG was observed. For enuresis type IIb, the effect of oxybutynin hydrochloride on the cystometrogram (CMG) was observed. RESULTS: Values, in which the awakening score on the second night was subtracted from the score on the last night, were significantly higher in the effective cases than in the unchanged cases. Out of the 3 patients in whom imipramine was effective, an awakening response on the EEG was observed in 2. Neither of the 2 unchanged cases showed an awakening response. Out of 4 patients in whom oxybutynin hydrochloride was effective, uninhibited contractions (UIC) on the CMG disappeared in 3. UIC stopped in neither of the 2 unchanged cases. CONCLUSIONS: Improvement of the awakening response plays an important role in the effectiveness of conditioning treatment with our therapeutic machine. The generation of awakening response is thought to be the most important result of imipramine directly concerned with its clinical effect on enuresis type IIa. The main result with oxybutynin hydrochloride in enuresis type IIb is thought to be related to its antispasmodic effect.

Physiological background of enuresis type I. A preliminary report.

The physiological background of enuresis Type I, which is due to a mild arousal dysfunction, has been investigated in two studies, one in rats and one in children with Type I enuresis. The results of these investigations suggest that in this type of enuresis, the fundamental arousal function following bladder distension, due to an arousal centre like the locus coeruleus and its network, is normal. In contrast, the process of multiplying the transient connection from light sleep to complete awakening, which probably relies upon functions of the thalamus and the further upper centrums, was thought to be abnormal.

[Long-term results of systematic treatment for nocturnal enuresis based on overnight simultaneous monitoring of electroencephalography and cystometry].

BACKGROUND: The long-term results of systematic treatment based on overnight simultaneous monitoring of electroencephalography (EEG) and cystometry in the patients with enuresis were evaluated. METHODS: From January to December a total of 213 patients were classified into 3 types. Enuresis Type I: such cases show a normal cystometrogram (CMG) with an awakening response on the EEG before enuresis, but they do not awake. Enuresis Type IIa; such cases show a normal CMG without an awakening response on the EEG. Enuresis Type IIb: such cases show an abnormal CMG with no awakening response on the EEG. When such cases enter the deep sleep stage, continuous uninhibited contractions of the bladder are observed on the CMG. 136 cases were of Type I, 20 cases of Type IIa, and 57 cases of Type IIb. RESULTS: Out of 213 patients who were followed up for 2 years, cured cases were 94 (44%), effective cases were 81 (38%) and unchanged cases were 38 (18%). In 136 patients with Type I, cured cases were 71 (52%), effective cases were 50 (37%) and unchanged cases were 15 (11%). In 20 patients with Type IIa, cured cases were 8 (40%), effective cases were 9 (45%) and unchanged cases were 3 (15%). In 57 patients with Type IIb, cured cases were 15 (26%), effective cases were 22 (39%) and unchanged cases were 20 (35%). The age of the effective group, which included cured cases and effective cases, was significantly higher than that of the unchanged group. In enuresis Type I, the percentage of the patients with incontinence in daytime were significantly in the unchanged group than in the effective group. No significant differences in the frequency of enuresis and the percentage of the patients who had awakened spontaneously by urinary sensation were found between the two groups. CONCLUSION: The therapeutic response was best in enuresis Type 1 and worst in enuresis Type IIb. The patients, in whom not only frequency of enuresis but also type of enuresis was unchanged by systematic treatment for two years, was approximately 10% across the types. Accordingly they were thought to be non-responders to this systematic treatment.

Urological abnormalities in 1,328 patients with nocturnal enuresis.

OBJECTIVES: Evaluation of the incidence of urological abnormalities as revealed by urological examinations of a large number of patients with enuresis. METHODS: Patients with the chief complaint of nocturnal enuresis were examined urologically. RESULTS: The incidence of urological abnormalities was 1.8% of 940 patients on intravenous pyelography (IVP), 7.1% of 695 patients on voiding cystourethrography (VCG) and 11.5% of 487 patients on cystometry (CM). No abnormal findings were observed in 58 patients on renal ultrasonography (US). 92.1% of reflux cases detected by VCG were low grade and only 8.9% of patients with reflux had pyuria. 20.2% of 446 patients who were submitted to all these examinations had some urological abnormality. Only pollakisuria was statistically more frequent in patients with urological abnormalities than in patients without them. CONCLUSION: These data suggest that the incidence of urological abnormalities was rather low when compared with the past literature. In particular, IVP was though to be unnecessary.

[Two cases of rhabdomyosarcoma of the bladder in children].

A 1-year-old boy was admitted to our hospital with chief complaint of urinary retention and a lower abdominal large mass. The mass was shown in the bladder by computerized tomography (CT) associated with paraaortic lymph node swelling. Tumor biopsy revealed rhabdomyosarcoma, embryonal type. Complete remission (CR) was obtained by chemotherapy based on STS' 88. He has been healthy 40 months without recurrence. A similar case of rhabdomyosarcoma, embryonal type, in the bladder in a 3-year-old girl with a chief complaint of macrohematuria was verified by CT and tumor biopsy. The same chemotherapy was performed, resulting in partial remission (PR). A complete resection of the tumor was achieved by partial cystectomy. She is alive without recurrence 18 months after the cystectomy.

[Ofloxacin concentration in prostatic tissue].

The concentration of ofloxacin in prostatic tissue and serum was determined in order to evaluate the permeability of ofloxacin into prostatic tissue in patients with benign prostatic hypertrophy. Ofloxacin was administered orally at a dose of 200 mg several hours before subcapsular prostatectomy. The determination was performed in the surgically removed adenoma and in the serum taken one hour before and at the removal of the adenoma. The peak level in the prostatic tissue was 1.46 microgram/g at 4.5 hour after the administration. The ratio of prostatic tissue level to the serum level was 1.00. In conclusion, ofloxacin was thought to be very useful for the treatment of acute and chronic prostatitis.

[Influential factors on the therapeutic response in the conditioning treatment of enuresis with an original therapeutic machine].

The conditioning treatment of enuresis with our original therapeutic machine, that is to awake the patient before enuresis may occur, has been performed since 1987. Influential factors on the therapeutic response were investigated. Twenty two patients with enuresis Type I were admitted and were treated for 5 nights with the therapeutic machine. Seven patients were cured (the cured group) and a certain effectiveness (decrease of the frequency of enuresis of more than 50%) was observed in 8 patients (the effective group). No effectiveness was obtained in 7 patients (the no change group). The average age of the cured group was higher than that of the no change group, and the difference was significant. No significant differences were found among the three groups in sex, the frequency of enuresis or the past experience of awakening before enuresis. Significant differences among the three groups were found in the average awakening score (how easily the patient awoke when a nurse called the patient after the machine alarmed) and the change of awakening score during treatment. The average awakening score of the cured group was the highest and that of the no change group was the lowest. The change of awakening score during treatment of the no change group was significantly lower than that of the cured group or that of the effective group. The desire to cure, scored 0-2 points at the time of discharge, was significantly stronger in the cured group than in the no change group. No significant differences were noticed among the three groups in the sleeping condition and the remembrance of awakening at the next morning.