Adenoviral nerve growth factor and beta-galactosidase transfer to spinal cord: a behavioral and histological analysis.

OBJECT: The present study characterizes the time course and loci of gene expression induced by the administration of adenoviral vectors into spinal cord. Although a marked inflammatory response to these vectors occurred, no effect on spinal cord function was seen in the 1st postoperative week. The expression of transgenic genes delivered by viral vectors is being exploited throughout the nervous system. The present study utilized adenoviral vectors containing the Rous sarcoma virus (RSV) promoter and a nuclear localization signal to achieve transgenic expression in mammalian spinal cord. METHODS: Initial experiments utilizing the vector Ad.RSVlacZ (10(12) particles/ml) injected into the region of the central canal resulted in viral gene expression stretching over approximately 1.2 cm of spinal cord. Gene expression was first detected 3 days following viral administration and lasted until postinjection Day 14 with peak expression at Day 7. A variety of cell types in both white and gray matter expressed lacZ. Transgenic expression of the neurotrophin nerve growth factor (NGF) was achieved using injections of Ad.RSVNGF. On histological examination mononuclear inflammatory infiltrate and gliosis were revealed surrounding the injection sites of spinal cords receiving adenovirus but not vehicle. To assess spinal cord function during viral gene expression, animals previously trained in an operant runway task were tested at 7 days postinjection (the peak of viral gene expression) and demonstrated no changes in spinal cord function. CONCLUSIONS: Results of this study using adenoviral neurotrophic gene transfer indicate that it provided an effective tool for the delivery of potentially therapeutic proteins to the injured or diseased spinal cord.

Transitional cell carcinoma arising in a pyelocaliceal cyst. An unusual cystic renal lesion with cytologic and imaging findings.

The differentiation between benign and malignant cystic lesions of the kidney is a diagnostic challenge. Medical imaging aids in this task, but many cystic renal lesions require further work-up, frequently by computed tomography-guided fine needle aspiration. We report on the pathological findings in a case of moderately differentiated papillary transitional carcinoma, which arose in a pre-existing pyelocaliceal cyst in a 53-year-old man. In the case of this lesion, the distinction between a benign and a malignant renal cyst is blurred. To our knowledge, this is the third such occurrence to be reported and the first to be diagnosed by fine needle aspiration biopsy.

Repeat male genital self-mutilation precipitated by urinary complications of prior repair.

Male genital self-mutilation is uncommon, with repeat mutilation even more rare. Our case is unique in that a urological complication of the first mutilating act (meatal stenosis) helped to precipitate the second incident. This case underscores the need not only for immediate urological and psychiatric care at the time of initial mutilation but also for close, combined followup care as well. In the majority of cases, when properly monitored, the men do not repeat the mutilating act.

Prostate biopsy in patients after proctectomy.

Until the discovery of prostate specific antigen as a tool to detect prostate carcinoma, the rectum has always been necessary to allow the best evaluation and biopsy of the prostate, whether by digital examination or transrectal ultrasound. We describe a simple, accurate, computerized tomography-guided method to biopsy the prostate in men who have undergone proctectomy.

Risks of blood volume changes in hypogonadal men treated with testosterone enanthate for erectile impotence.

Administration of anabolic steroids carries many risks. We present a series of 15 patients with primary hypogonadism who as a group had statistically significant increases in whole body hematocrit and red blood cell volume while on testosterone therapy of 300 mg. intramuscularly every 3 weeks. A small decrease in plasma volume over-all was not significant. Subsequent analyses compared subgroups whose whole body hematocrit during testosterone therapy was either 48% or greater (9) or less than 48% (6). Interaction effects indicated that the subgroups were similar when off testosterone but when on testosterone the former group exhibited an increase in red blood cell volume and a decrease in plasma volume, while the latter group had little change in either measurement. Subsequent to stopping testosterone therapy 2 patients in the whole body hematocrit 48% or greater group suffered strokes and 1 had transient ischemic attacks while on therapy. No one in the whole body hematocrit less than 48% group has had any cerebrovascular symptoms. Clinical implications, as well as cost-effective and practical suggestions for detecting possible dangerous hemoconcentration are discussed.

Metastatic carcinoma of prostate 23 years after radical prostatectomy.

Carcinoma of the prostate may present with metastatic disease many years after treatment. We present a patient with adenocarcinoma of the prostate, "cured" by radical perineal prostatectomy in 1962, with the first signs of metastases presenting in 1985. This emphasizes the importance of long-term follow-up of patients with prostate carcinoma.

In treating impotence, urology and sex therapy are complementary.

Urologists and mental health professionals are neither competitors nor adversaries. The principles of sex therapy represent a thoughtful and sensitive way to approach patients with almost any clinical problem so that they are more comfortable with the recommended tests or treatments. Sex therapy may be very helpful as an adjunct in treating "organic" as well as primarily emotional erectile dysfunction. We believe that with information we can help build a bridge between urologists and mental health professionals.

Sex reversal syndrome (XX male).

Men who appear normal and live a normal life, may have a 46,XX karyotype and present with the typical features of infertility and end organ (testicular) failure. They are azoospermic and their small testicles show specific patterns on light and electron microscopy. Recent advances in genetics (1) favor the "X-Y interchange" theory to explain this phenomenon; (2) hypothesize about the roles of the H-Y antigen and testis determining factor (TDF) in determining "maleness"; and (3) allow mapping of the relative positions of H-Y and TDF loci on the Y chromosome.

Renal failure after intravesical mitomycin C.

Severe side effects, local or systemic, are uncommon with intravesically administered mitomycin C. Bladder fibrosis and contracture, with resultant renal failure, are unusual but possible.

Use of the malleable penile prosthesis in the treatment of erectile dysfunction: a prospective study of postoperative adjustment.

Much of the research on the postoperative adjustment of penile prosthesis recipients and their partners has been hampered by retrospective designs, unreliable assessment procedures and other methodological limitations. To address these shortcomings and to increase current knowledge regarding postoperative adjustment, we completed a prospective, longitudinal study of 19 implant recipients and their partners. Our results suggest that most patients and partners were satisfied with the prosthesis 1 year postoperatively, although use of the prosthesis sometimes was accompanied by short-term complications. Satisfaction tended to be lower among spouses than patients. Frequency of sexual intercourse increased during the followup period but there were no changes in sexual desire. Neither marital nor psychological adjustment changed significantly during this period.

Differentiating the etiology of male erectile dysfunction using the Millon Behavioral Health Inventory and self-report measures.

This study examines the effectiveness of using the Millon Behavioral Health Inventory in conjunction with self-report measures of erectile dysfunction to classify the etiology of erectile dysfunction in males. Subjects were 70 males with erectile dysfunction. The results indicate that 47% of the subjects with psychogenic etiology, 65% with mixed etiology, and 71% of the subjects with organic etiology were correctly classified. These and previous findings indicate that the MBHI is an effective method of assessing the etiology of erectile dysfunction.

Success and failure in penile prosthesis surgery: two cases highlighting the importance of psychosocial factors.

Two cases, carefully selected from a longitudinal, prospective investigation of the relationship between psychosocial variables and postsurgical adjustment to a penile prosthesis implantation, were studied intensively. In both cases, the patient and sexual partner were assessed, presurgically, on a number of psychological, marital, and sexual functioning variables; their subsequent satisfaction with the prosthesis, and their psychological, marital, and sexual adjustment were measured at 6 and 12 months postsurgery. Despite many similarities in medical aspects of the surgery, for one couple a successful outcome was evidenced, whereas the other couple demonstrated a therapeutic failure despite the technical success of the surgery. Psychosocial differences between the couples were identified as they may relate to the discordant outcomes observed. Clinical implications of these results are discussed, as are the strengths and weaknesses of our methodological approach.

Management of impotence. II. Selected surgical procedures: penile prostheses.

Ingenious technological advances have been made in the surgical management of male erectile dysfunction, specifically in the form of implantable penile prostheses. These devices have also been the subject of great debate and commercial competition. Their common denominators are that each will provide an effective, enjoyable erection, they are well tolerated by patients and their partners, and the surgical success is dependent on the patient's and the partner's emotions.

Single cylinder penile prosthesis.

The single cylinder penile prosthesis is a viable procedure. It has many advantages. Its success depends on the careful selection, counseling, and follow-up of the patients and their partners.

Cutaneous vasostomy: technique for treatment of chronic and recurrent epididymitis.

We describe a method for treatment of patients with chronic and recurrent epididymitis. Six of 7 patients (86%) treated with this procedure between 1977 and 1980 have had no recurrent episodes of epididymitis to date. We discuss the comparative benefits of this procedure as related to other surgical treatments for acute, chronic, and recurrent epididymitis.

Comparison of 99mTc phosphate and diphosphonate complexes in experimental renal infarcts.

The 3-hour biodistribution of 99mTc complexes of five diphosphonates (HMDP, NMMDP, DMAD, DPD, and APD), imidodiphosphonate (IDP), and pyrophosphate (PYP) was compared in rats with segmental renal infarction induced by a 1-hour occlusion of a renal artery branch. 95mTc labeled MDP was a reference substance in all animals. Three agents (APD, HMDP and IDP) had a higher infarct/normal kidney concentration ratio than MDP, the latter two by virtue of a lower content in normal kidney. HMDP, DPD, and IDP had very high liver concentrations. DPD showed relatively high concentrations in soft tissues and blood. The blood and kidney levels of PYP were higher than those of MDP but the infarct/normal kidney ratios were similar. None of the agents had a higher uptake in bone than MDP: four had a significantly lower uptake. The increased concentration of 99mTc MDP in the infarcts was readily seen in camera images one day after renal artery occlusion, but not at three or seven days. Increased diphosphonate uptake was accompanied by an influx of calcium in both cortex and medulla. The accumulation of diphosphonate in areas of infarction was not modified by infusions of verapamil or Captopril.