Prevalence of major depressive disorder in self-referred patients in a late onset hypogonadism clinic.

The goal was to clarify the rate of major depressive disorder (MDD) in self-referred patients who visited our late onset hypogonadism (LOH) clinic and the importance of screening of MDD in LOH clinic. Two hundred consecutive self-referred patients who visited our LOH clinic were evaluated. MDD was diagnosed using, the Mini International Neuropsychiatric Interview (MINI) questionnaire. Scores of the Aging Males Symptom (AMS) scale were compared between the MDD and non-MDD groups with and without low testosterone values. Forty-two percent of all patients were categorized into the MDD group. Only 4% of the patients were considered to be LOH. The MDD group had significantly higher scores on the AMS scale than the LOH and non-MDD with normal testosterone groups. In conclusion, significant numbers of undiagnosed MDD patients visited the LOH clinic. Screening for MDD is an essential step in the LOH outpatient clinic.

Vascularised bone graft from the base of the second metacarpal for refractory nonunion of the scaphoid.

A vascularised bone-graft procedure from the base of the second metacarpal was performed in 14 patients with nonunion of the scaphoid. There were 11 men and three women with a mean age of 22 years. In eight patients, who had dorsiflexed intercalated segment instability (DISI), an open wedge was formed at the site of nonunion, and the vascular pedicle was grafted from the volar side. In the six patients without DISI, transplantation was carried out through the same dorsal skin incision. Complete bony union was obtained in all patients after a mean post-operative period of 10.2 weeks, and DISI was corrected in all affected patients. According to Cooney's clinical scoring system, the results were excellent in five, good in six, and fair in three patients. Because of its technical simplicity and the limited dissection needed, the procedure should be considered for the primary surgical treatment of patients with nonunion of the scaphoid.

[Mucosa-associated lymphoid tissue lymphoma; report of two cases].

Primary pulmonary malignant lymphoma is a rare disease that is thought to belong to a category of malignant lymphomas arising from mucosa-associated lymphoid tissue (MALT). We presented 2 cases of MALT lymphoma. Case 1: In a 39-year-old woman, an abnormal shadow was detected in chest radiography in the left S3. The diagnosis was organizing pneumonia in consequence of the further examination. One year after an growing abnormal shadow was detected again, we performed the tumor resection with the thoracoscopy in the possibility of malignancy. The pathological diagnosis was MALT lymphoma. Case 2: In a 70-year-old man, middle lobe syndrome was detected in chest radiography. As a result of the bronchial biopsy, the lesion was suspected of MALT lymphoma. Right middle lobectomy was performed, and the tumor was diagnosed as a MALT lymphoma histologically. He underwent an effective postoperative radiotherapy and has had no evidence of recurrence.

[Availability of NMP22 (nuclear matrix protein 22) for the diagnosis of urothelial cancer].

We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.

Inverse association of Chlamydia pneumoniae infection with high blood pressure in Japanese adults.

To determine whether Chlamydia pneumoniae (C. pneumoniae) infection is associated with hypertension in Japanese adults, we measured serum levels of IgA (a marker of reinfection) and of IgG (a marker of previous infection) antibodies to C. pneumoniae by enzyme-linked immunosorbent assay in 112 adults including normotensive and untreated hypertensive subjects and in 117 hypertensive subjects who had been receiving treatment for more than 3 years. In 112 adults, positivity rate for IgA was lower (P < .01) in hypertensive than in normotensive or borderline hypertensive subjects. Positivity rates for IgA and IgG together, which indicate persistent infection of C. pneumoniae, were lower (P < .01) in hypertensive than in normotensive subjects. IgA levels were inversely correlated with systolic blood pressure (SBP) (r = 0.530, P = .0001) and with diastolic blood pressure (DBP) (r = 0.398, P = .0001). In the 117 hypertensive subjects treated with medication, positivity rate for IgA was lower (P < .01) in subjects with poor control than in those with good control. Positivity rates for IgA and IgG together were lower (P < 0.01) in the poor control group than in the good or fair control groups. IgA levels were correlated inversely with SBP and DBP. In both 112 adults and 117 hypertensive patients, levels of SBP or DBP were inversely associated with positivity rates for IgA and IgG together in multiple logistic regression analysis. The results suggest an inverse relationship between high blood pressure and C. pneumoniae infection in Japanese adults.

[Small cell carcinoma of the urinary bladder: a case report].

We report a case of small cell carcinoma of the urinary bladder. A 60-year-old man with microscopic hematuria was referred to our hospital. Cystoscopy revealed a sessile tumor on the left lateral wall of the urinary bladder. The patient underwent transurethral resection of the bladder tumor (TUR-Bt). Because of muscle invasion (pT2), total cystectomy was recommended, but was not performed because the patient would not give consent for the operation. Six months after TUR-Bt, invasive bladder tumor recurred and total cystectomy was performed. Pathological examination of the operative specimen revealed small cell carcinoma. Adjuvant combined therapy of irradiation and chemotherapy (nedaplatin and etoposide) was ineffective. Metastases to retroperitoneal lymph nodes, lung and liver were detected soon after the adjuvant therapy. The patient died 15 months after his first visit to our hospital.

A stone developed within the dilated intravesical ureter following ureteroscopy.

A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.

Eicosapentaenoic acid stimulates nitric oxide production and decreases cardiac noradrenaline in diabetic rats.

1. The aim of the present study was to investigate whether long-term oral administration of eicosapentaenoic acid increases nitric oxide (NO) production and affects cardiac sympathetic activity in rats with diabetes mellitus. 2. We measured changes in urinary excretion of NO3-, a stable NO metabolite, and cardiac noradrenaline (NA) concentrations in non-diabetic rats and streptozotocin-induced diabetic rats treated with either ethyl icosapentate (EPA-E; 100 mg/kg per day; n = 10), a purified ethyl esterification product of eicosapentaenoic acid, or vehicle (distilled water; n = 10) for 6 weeks. The effects of N(G)-nitro-L-arginine (L-NNA), a NO synthase inhibitor, on urinary NO3- excretion and cardiac NA concentrations were also investigated in diabetic rats treated with EPA-E. 3. Urinary NO3- excretion was higher at weeks 5 and 6 in diabetic rats treated with EPA-E than in diabetic rats treated with vehicle (week 5: 120+/-8 vs 51+/-11 micromol/g per day, respectively (P<0.01); week 6: 279+/-83 vs 73+/-9 micromol/g per day, respectively (P<0.01)). Cardiac NA concentrations were higher in diabetic rats than in non-diabetic rats and were decreased in the left atrium and both ventricles in diabetic rats treated with EPA-E compared with control. Systemic administration of L-NNA abolished the increase in urinary excretion of NO3- and the decrease in cardiac NA concentrations in diabetic rats treated with EPA-E. 4. Long-term oral administration of EPA-E may stimulate NO production and increased NO is likely to play a role in inhibiting enhanced cardiac sympathetic activity in diabetic rats.

[Silicate calculi: report of two cases].

Two patients, aged 53 and 55, discharged stones spontaneously. Infrared spectrophotometry of the stones demonstrated silicate. They had no history of taking magnesium silicate. Thirty cases of silicate calculi previously reported in the Japanese literature are reviewed.

A case report of synovitis, acne, pustulosis, hyperostosis and osteitis syndrome presenting with spondylodiscitis.

SAPHO syndrome stands for synovitis, acne, pustulosis, hyperostosis and osteitis. The common site of skeletal lesions in this syndrome is the sternocostoclavicular area. Spondylodiscitis is rarely described in published studies. In general, skin lesions develop before the onset of skeletal lesions. We report a case of SAPHO syndrome in which spondylodiscitis developed more than 1 year before the onset of pustulosis.

Production, characterization, and application of monoclonal antibodies which distinguish four glucosyltransferases from Streptococcus sobrinus.

A 1,3-alpha-glucan synthase (GTF-I), a highly branched 1, 6-alpha-glucan synthase (GTF-U) and a 1,6-alpha-glucan synthase (GTF-T) were purified to near homogeneity from the culture fluid of Streptococcus sobrinus strain B13N (serotype d) and characterized. In addition, a crude preparation of a recombinant oligo-isomaltosaccharide synthase (rGTF-S) was prepared from a cell-free extract of Escherichia coli MD124 transformant. Using four homogeneous GTF preparations including previously purified rGTF-S as antigens for immunization, 11 murine hybridomas producing a monoclonal antibody (MAb) were established through the fusion of myeloma cells (P3X63-Ag8-U1) and spleen cells of immunized BALB/c mice. When the immunoreactivities of the resultant MAbs were tested, all five MAbs raised against GTF-I, all three MAbs raised against GTF-T, and two of three MAbs raised against GTF-U reacted specifically with the homologous enzyme alone, while one MAb (B86) raised against GTF-U cross-reacted strongly with all GTFs. Although no MAb monospecific for rGTF-S was obtained, precise recognition of GTF-S was possible using the nonspecific B86 antibody together with the MAbs monospecific for the three glucan synthases. Thus, a set of four typical MAbs (B17, B76, B19 and B86) were successfully used for the identification of gene products expressed in 24 previously constructed E. coli phage clones, and the findings suggested that six phage clones might express a gtfU gene encoding GTF-U which has not been hitherto isolated.

[A case of transitional cell carcinoma of the bladder in a juvenile patient].

A case of transitional cell carcinoma of the bladder in a 18-year-old female is presented. Cystoscopic examination revealed a papillary tumor on the left lateral wall. Histopathology of the excised tumor showed transitional cell carcinoma, G1 > 2, pT1a. Recurrence has not been observed for about 1 year, after intravesical pirarubicin therapy.

Active MR tracking on a 0.2 Tesla MR imager.

An active MR tracking system was implemented on a 0.2 Tesla open MRI system. Interventional devices with receive-only microcoils at their tips were developed and investigated on the scanner. Microcoils having a diameter of about 1 mm and 20 turns were found to provide sufficient signal-to-noise ratios for stable tracking. Positional accuracy and precision were found to be acceptable under practical conditions. Simulation of MR-guided biopsy using biplane images with tracking was performed in a gelatin phantom and dog livers. Successful tracking of catheters with integrated microcoils was also demonstrated in the aorta and IVC of live dogs.

Increased vitreous concentrations of human hepatocyte growth factor in proliferative diabetic retinopathy.

Human hepatocyte GF (hHGF) has strong neoangiogenesis activity. The present study was designed to investigate the possible involvement of hHGF in neovascularization in proliferative diabetic retinopathy (PDR) by measuring vitreous hHGF concentrations. The mean vitreous hHGF concentration was higher in subjects with PDR (5.70 +/- 0.68 ng/mL, n = 33) than in nondiabetic control subjects (1.50 +/- 0.20 ng/mL, n = 18, P < 0.01), nondiabetic subjects with proliferative vitreoretinopathy (3.31 +/- 0.57 ng//mL, n = 10, P < 0.05), or diabetic subjects without PDR (1.29 +/- 0.28 ng/mL, n = 8, P < 0.01). PDR subjects with neovascularization of iris, which suggests advanced retinal ischemia, showed a higher mean vitreous hHGF concentration than those without iridal neovascularization [7.33 +/- 1.16 ng/mL (n = 14) vs. 4.49 +/- 0.72 ng/mL (n = 19), P < 0.05]. The mean vitreous hHGF concentration was higher in PDR subjects with retinal neovascularization at the optic disc than in those with neovascularization elsewhere [7.3 +/- 1.1 ng/mL (n = 15) vs. 4.4 +/- 0.7 ng/mL (n = 18), P < 0.05]. Our results indicate that vitreous hHGF may play a role in retinal neovascularization in PDR.

[Clinical statistics at the urological clinic of Sanjukai Hospital--statistics on new outpatients over the last five years].

We herein report the clinical statistics on new outpatients over five years from 1994 at our hospital. The average number of new outpatients per year was 8,534.4 (8,366-8,658) and there was only a slight variation in the number over the last five years. The male to female ratio was 1.61:1. Twenty-one percent of the outpatients were referred to us by other sources. The representative operations on outpatients were circumcision, vasectomy, resection of condylomas and resection of caruncles. A statistical study was made on new outpatients according to the international classification of disease. There were 197.0 (2.3%) malignant urogenital tumors per year. There was a tendency for sexually transmitted diseases to increase over the last five years. In males, the major diseases were upper urinary tract stones (23-27%), benign prostatic hypertrophy (19-26%) and prostatitis (15-24%). In females, they were cystitis (57-59%), upper urinary tract stones (17-18%) and neurogenic bladder (3-4%). We conclude that our hospital plays a major role as a private urological hospital.

[Neovascularization and HGF: neovascularization in proliferative diabetic retinopathy and intraocular HGF].

Human hepatocyte growth factor (hHGF) has a strong angioneogenetic action. The present study was designed to investigate the possible involvement of hHGF in neovascularization in proliferative diabetic retinopathy by measuring vitreous hHGF concentration, and to examine the gene expression of hHGF in retinal Müller cells, which are presumed to play a role in proliferative diabetic retinopathy. Patients who had undergone pars plana vitrectomy were studied (33 diabetic patients with proliferative retinopathy and 20 nondiabetic subjects). The mean vitreous hHGF concentration was higher (p < 0.0001) in diabetic subjects with proliferative retinopathy (5.7 +/- 0.7 ng/ml) than in nondiabetic subjects (1.6 +/- 0.2 ng/ml). Furthermore, diabetic subjects with iris neovascularization, which is suggestive of advanced retinal ischemia, showed higher values of mean vitreous hHGF concentration than those without iris neovascularization (7.3 +/- 1.2 ng/ml [n = 14] vs. 4.5 +/- 0.7 ng/ml [n = 19], p < 0.01). Expression of hHGF gene was detected in cultured human Müller cells. Our results indicate that hHGF may be produced in the eye by retinal cells such as Müller cells and may play a role in neovascularization of proliferative diabetic retinopathy.

Roles of brain angiotensin II and C-type natriuretic peptide in deoxycorticosterone acetate-salt hypertension in rats.

OBJECTIVE: To investigate the roles of brain angiotensin II and C-type natriuretic peptide (CNP) in the hypertensive mechanism of deoxycorticosterone acetate (DOCA)-salt hypertension. METHODS: We injected 50 microg/kg CV-11 974, an angiotensin II type-1 receptors antagonist, 30 nmol/kg CNP-22, or the vehicle (artificial cerebrospinal fluid) into the cerebral ventricle or intravenously 5 min before the intracerebroventricular infusion of 1.5 mol/I NaCl solution for 30 min into either male normotensive Wistar rats or DOCA-salt hypertensive rats anesthetized with urethane, and their arterial pressures and heart rates were continuously recorded. Blood (2 ml) was collected at the end of the infusion for the measurement of plasma concentration of arginine vasopressin. We infused 10 or 50 microg/kg per day CV-11 974, 10 or 50 nmol/kg per day CNP-22, or the vehicle (1 microl/h) into the cerebral ventricles of DOCA-salt hypertensive rats for 7 days by using osmotic minipumps, and measured their systolic arterial pressures, pulse rates, and urinary excretions of vasopressin. RESULTS: Intracerebroventricular pre-administrations of CV-11 974 and of CNP-22 inhibited increases in mean arterial pressure, heart rate, and plasma vasopressin concentration induced by intracerebroventricular infusion of 1.5 mol/l NaCl into normotensive rats; increases in hemodynamics and plasma level of vasopressin induced by intracerebroventricular infusion of 1.5 mol/l NaCl were suppressed by intracerebroventricular pre-injections of CV-11 974, but not of CNP-22, into DOCA-salt hypertensive rats. Continuous intracerebroventricular infusions of 50 microg/kg per day CV-11 974 attenuated hypertension in DOCA-salt treated rats, accompanied by a reduction in urinary excretion of vasopressin. Continuous intracerebroventricular infusions of 50 nmol/kg per day CNP-22, however, affected neither hypertension nor urinary excretion of vasopressin in DOCA-salt hypertensive rats. CONCLUSION: Brain angiotensin II could play a role in the pressor mechanism of DOCA-salt hypertension by increasing release of vasopressin via type 1 receptors. That brain CNP has an inhibitory effect on release of vasopressin in acute experiments indicates that the impairment of this inhibitory effect of brain CNP on secretion of vasopressin could be involved in the pathogenesis of DOCA-salt hypertension in rats.

Lower than normal expression of brain nitric oxide synthase gene in the hypothalamus of deoxycorticosterone acetate-salt hypertensive rats.

OBJECTIVE: To elucidate the role of brain nitric oxide produced by neuronal constitutive nitric oxide synthase in sodium-induced hypertension. DESIGN AND METHODS: Diets containing a high (8% NaCl), a medium (2% NaCl), and a low (0.2% NaCl) sodium content were administered to Wistar rats aged 12 weeks for 10 days or 8 weeks until they were killed. Male Wistar rats administered either deoxycorticosterone acetate, 1% NaCl or both and the respective controls were killed 2 weeks (during prehypertensive stage) or 6 weeks (during hypertensive stage) after the start of treatment. The hypothalamus and lower brainstem were excised for extraction of total RNA. Reverse transcription polymerase chain reactions of constitutive nitric oxide synthase messenger RNA and glyceraldehyde-3-phosphate dehydrogenase messenger RNA were performed, and constitutive nitric oxide synthase messenger RNA levels were expressed relative to glyceraldehyde-3-phosphate dehydrogenase messenger RNA levels. RESULTS: A high sodium intake for 10 days tended to decrease constitutive nitric oxide synthase messenger RNA levels in the hypothalamus, compared with effect of a low sodium intake. Constitutive nitric oxide synthase messenger RNA levels in the hypothalamus of deoxycorticosterone acetate-salt hypertensive rats were lower than those in the control sham-operated rats. Neither alteration of sodium intake nor administration of deoxycorticosterone with and without sodium affected constitutive nitric oxide synthase gene expression in the lower brainstem. CONCLUSIONS: Expression of neuronal constitutive nitric oxide synthase gene is downregulated in the hypothalamus of deoxycorticosterone acetate-salt hypertensive rats. This lower than normal expression of neuronal constitutive nitric oxide synthase gene in the hypothalamus could be an adaptive response to sodium-induced hypertension, and suggests that nitric oxide produced by hypothalamic constitutive nitric oxide synthase plays a role in maintenance of blood pressure in relation to sodium balance in rats.

Effects of surfactants on glucosyltransferase production and in vitro sucrose-dependent colonization by Streptococcus mutans.

The presence of Tween 80 in media was associated with a significant increase in three glucosyltransferases(GTFs)(I, SI and S), especially GTF-I, produced by Streptococcus mutans strain PS14, indicating that the surfactant is a major cause of the enhanced GTF production observed in cultures in M4 medium. Lecithin and Tween 20 also enhanced GTF-I production, while Triton X-100 depressed it. At a lot concentration of 0.00125%, Tween 80 enhanced markedly only GTF-I production and its effect reached maximum at a concentration of 0.0025%. Water-insoluble glucan synthesis and artificial plaque formation (in vitro sucrose-dependent colonization) by PS14 were significantly enhanced by the addition of Tween 80 at concentrations over 0.00125%. These results suggest that surfactants might vary the cariogenic potential of Strep. mutans even at low concentrations.