Ulcer perforation in gastric urinary conduit: never use a gastric segment in the urinary tract if there are other options available.

A male patient, who had had a conservatively treated hemorrhagic peptic ulcer 12 years earlier, underwent gastrocystoplasty after radical cystoprostatectomy for carcinoma of the urinary bladder. After operation the patient suffered urinary incontinence and dysuria which he found so bothersome that the gastric bladder was converted to diversion using the same gastric segment as a tube. Postoperatively there were clots of blood in stomal urine and after the kidneys had been drained intestinal fluid oozed from the stoma. On the 14th postoperative day the patient died of pulmonary embolism. The autopsy showed a perforated peptic ulcer in the gastric segment resulting in a closed fistula to the small bowel. Most probably the reason for development of the peptic ulcer was stress caused by the operation and it might have been avoided by using hydrogen-blocking agents. This case seriously questions whether a gastric segment should be used in the urinary tract at all, and at least it should never be used as a conduit.

Primary malignant melanoma of the urinary bladder associated with widespread metastases.

Malignant melanoma in the urinary tract is very rare. Tumours found in the urinary bladder are usually metastatic. Some ten cases of primary malignant melanoma have been described in the literature, and in only a few of those has a primary bladder melanoma with many distant metastases and rapid fatal outcome been reported. For the first time in Finland, we present a case of primary malignant bladder melanoma associated with widespread metastases.

A chance of misdiagnosis between acute appendicitis and renal colic.

The symptoms of right-sided renal colic mimic sometimes acute appendicitis. A prospective comparative study of 188 patients with ureteral stone and 188 patients with acute appendicitis was performed to evaluate the features of differential diagnosis. Appendicitis caused more often nausea (81 vs 11%), fever and localized pain in the McBurney (97 vs 59%) than renal colic. The patients with ureteral stone had tenderness in 16% in the right lower quadrant. The mean values of C-reactive protein (41 mg/l) and blood leukocytes (14 x 10(9)/l) were elevated in appendicitis, but not in renal colic (14 mg/l and 10 x 10(9)/ l). Urinanalysis revealed red cells in 92% of ureteral stones compared with 26% in appendicitis. Only one of 188 patients with appendicitis was first misdiagnosed to have renal colic. A mistake of appendicitis for ureteral stone is clinically rare occurring only once or twice per year in the hospital where 700-800 emergency appendectomies are annually performed.

Peptidergic innervation of the human prostate, seminal vesicle and vas deferens.

Neuropeptidergic innervation of the human prostate, seminal vesicle and vas deferens was investigated by immunohistochemical methods. The innervation pattern of all organs was very dense. Neuropeptide Y- and tyrosine hydroxylase-positive nerve fibers were most abundant and localized mainly in the smooth muscle layer. On the contrary, vasoactive intestinal polypeptide-positive nerve fibers were mainly found beneath the epithelium. Also leu-enkephaline-, peptide histidine isoleusine- and calcitonin gene-related peptide-positive nerve fibers could be observed in all organs, but somatostatin-positive nerves only in the prostate and seminal vesicle and met-enkephalin- and substance P-positive nerves only in the prostate.

Peptidergic innervation of the human testis and epididymis.

Neuropeptidergic innervation of the human testis and epididymis was investigated by immunohistochemical methods. The innervation of the epididymis was more dense than that of testis. In the testis only tyrosine hydroxylase- and neuropeptide Y-positive nerves could be found between seminiferous tubules and around blood vessels. In the connective tissue capsule of the testis also small calcitonin gene-related peptide- and metenkephalin-containing nerve fibres were seen. The epididymis was densely innervated by nerve fibres immunoreactive to tyrosine hydroxylase, neuropeptide Y, vasoactive intestinal polypeptide, calcitonin gene-related peptide, galanin, peptide histidine isoleusine and substance P.

Peptidergic innervation of human sphincter of Oddi.

The innervation of the sphincter of Oddi (SO) has been extensively studied experimentally, but human studies have not been published, which is why this study was undertaken. Biopsies, taken by gastroscopy-biopsy forceps from duodenal epithelium of the papilla of Vater and from ampullary epithelium after sphincterotomy, did not demonstrate nerves and could not be used for studying SO innervation. Therefore SO specimens were obtained from brain-dead organ donors (N = 5) and from autopsies (N = 14). By staining with a myelin marker S-100, a rich network of nerves was demonstrated in SO. The occurrence of vasoactive intestinal polypeptide (VIP), peptide histidine-isoleucine (PHI) (or its immunologically similar human equivalent peptide histidine methioninamide, PHM), neuropeptide Y, calcitonin gene-related peptide (CGRP), galanin, substance P, enkephalin, bombesin, and somatostatin were studied by immunohistochemical technique. SO demonstrated immunoreactivity for VIP, PHI (PHM), neuropeptide Y, CGRP, galanin, somatostatin, substance P, and enkephalin, but no immunoreactivity was observed for bombesin. The SO immunoreactivity was similar in specimens from organ donors and from autopsies of victims of violence without pancreatobiliary diseases (N = 3) when the specimens were taken within 48 hr of death. Autopsy specimens of SO from subjects with gallstone disease (N = 5), recurrent pancreatitis (N = 3) or periampullary carcinoma (N = 3) also demonstrated similar immunoreactivity. We conclude that VIP-, PHI- (PHM-), neuropeptide Y-, CGRP-, galanin-, substance P-, somatostatin-, and enkephalin-like immunoreactivity occur in human SO. These neuropeptides may have role in the neural control of human SO function.

Study of tyrosine hydroxylase and neuropeptidergic innervation of the human obstructed pelveoureteral junction in four different patients.

Tyrosine hydroxylase and neuropeptidergic innervations of the obstructed pelveoureteral junctions of four different patients were investigated by immunohistochemical methods. A dense innervation of tyrosine hydroxylase- and neuropeptide Y-nerves was found especially in the pelveoureteral junction, which was congenitally obstructed, compared to others found later (13- and 23-year old females). Also quite numerous vasoactive intestinal polypeptide-nerves were seen as well as some calcitonin gene-related peptide-, galanin- and substance P-nerves in the muscular layer of ureter. The innervation pattern of the obstructed pelveoureteral junction of the horseshoe kidney was found to be normal.

Neuropeptidergic innervation of the human male distal urethra and intrinsic external urethral sphincter.

The innervation of the human male distal urethra and intrinsic external urethral sphincter was investigated by immunohistochemical techniques. The innervation density was low. In the urethra neuropeptide, and vasoactive intestinal polypeptide positive nerves were found in the muscular layer, calcitonin gene-related peptide, galanin and PHI nerves were localized in the epithelium. In the intrinsic external urethral sphincter NPY and galanin nerves were quite numerous between the striated muscle bundles, calcitonin gene-related peptide, vasoactive intestinal polypeptide and PHI were only seen occasionally as thin fibres.

Neuropeptides in pig sphincter of Oddi, bile duct, gallbladder, and duodenum.

To better understand the complex structure and function of the sphincter of Oddi (SO), the occurrence and localization of nine neuropeptides, including vasoactive intestinal polypeptide (VIP), bombesin, neuropeptide Y, peptide histidine-isoleucine (PHI), calcitonin gene-related peptide (CGRP), galanin, substance P, serotonin, and somatostatin, were studied by immunohistochemical methods in the pig SO. The SO innervation was compared to gallbladder, common bile duct, and duodenal innervation. Specimens from the SO, gallbladder, common bile duct, and duodenum demonstrated a rich network of nerves, as suggested by light microscopy and confirmed by a myelin marker S-100. SO demonstrated very strong immunoreactivity for VIP, strong immunoreactivity for neuropeptide Y and galanin, moderate immunoreactivity for PHI and CGRP, and borderline immunoreactivity for bombesin and substance P. Serotonin and somatostatin immunoreactivity was also observed, not in the nerves, but in some of the epithelial cells. The gallbladder innervation was virtually identical to the SO innervation, whereas common bile duct and duodenal innervation were slightly different. To our knowledge this is the first time that galanin- and PHI-like immunoreactivities have been observed in the SO. Our observations suggest that these peptides, along with VIP, neuropeptide Y, and CGRP, might play a role in the neural control of biliary motility.

Spontaneous peripelvic extravasation of urine as a cause of acute abdomen.

In eight patients with sudden onset of flank pain, urography showed extravasation of urine. The cause of peripelvic leakage was verified ureteral stone in four cases, stricture of the ureteropelvic junction in one, and unknown in three cases. Treatment was symptomatic in four cases, drainage in two and surgery in two cases. Seven patients recovered uneventfully, but one required nephrectomy. The prognosis in spontaneous urinary extravasation is usually good without drainage. Open surgery is seldom indicated.

Peptidergic innervation of the normal and obstructed human pyeloureteral junctions.

The neuropeptidergic innervation of the normal and obstructed human pyeloureteral junction was investigated using immunohistochemical techniques. A dense innervation of neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) in the intrinsic obstruction type was demonstrated. NPY and VIP formed networks in the muscular layer. NPY was also found in perivascular plexuses and VIP adjacent to the epithelium. Calcitonin gene-related peptide, galanin and substance P nerves were also seen in the muscular layer, although sparsely. It is proposed that NPY and VIP have a role in the pathophysiology of the intrinsic obstruction type of the human pyeloureteral junction. The innervation pattern of the junction with the external type of obstruction was similar to that of the normal pyeloureteral junction.

Electromyography and morphology during regeneration of muscle injury in rats.

Healing of the partially ruptured rat gastrocnemius muscle was studied correlating electromyographical findings with morphological changes. Fibrillation potentials and positive sharp waves were seen both proximal and distal to the injury 7 days after the injury and disappeared in the proximal part by day 14 and in the distal part by day 21. Late components of motor action potential were observed from day 14 onwards. Denervation was mainly myogenic, i.e. caused either by rupture of myofibres, whence the abjunctional stump lost its contact with the neuromuscular junction on the adjunctional stump, or by necrosis of the segment of the ruptured myofibre lying underneath the neuromuscular junction. Lesser extent of denervation was neurogenic, i.e. caused by damage to intramuscular nerve fibres. The reinnervation occurs either by regeneration of the necrotized myofibres, by regeneration of the severed nerves, or by collateral innervation of new neuromuscular junctions in the abjunctional stumps. The present study indicates that electromyography may be useful in the diagnosis and follow-up of skeletal muscle injuries.

Light and electron microscopic immunocytochemical demonstration of intraepidermal CGRP-containing nerves in human skin.

The distribution of nerves immunoreactive to calcitonin gene-related peptide (CGRP) was studied in human skin with special reference to the intraepidermal nerve fibres. It was shown by light and electron microscopy that a small proportion of the CGRP immunoreactive nerves entered the epidermis. The majority of the nerves ended as free nerve terminals subepidermally. Intraepidermal nerve endings were mainly seen in skin areas, which have a dense sensory innervation, such as fingertips and foreskin. The role of the peptidergic nerves in human skin is discussed.

Electron microscopic study on the innervation of the human axillary sweat glands.

The innervation of human axillary sweat glands was studied at electron microscopic level. Nerve endings with many small agranular vesicles and few large dense-cored vesicles were found outside the basement membrane of the secretory coils. These nerve endings can be classified as cholinergic. This result confirms the previous knowledge that axillary sweat glands are innervated by sympathetic cholinergic nerves.

The distribution of substance P-, CGRP-, galanin- and ANP-like immunoreactive nerves in human sweat glands.

The distribution in immunoreactivities towards atrial natriuretic peptide, calcitonin gene-related peptide, galanin and substance P were demonstrated in human skin at the light and electron microscopic levels. Nerves immunoreactive to the first three of these peptides were found around eccrine sweat glands, whereas only a few positively-labelled nerve fibres could be seen around apocrine glands. At the ultrastructural level, immunoreactivity to the neuropeptides was localized in the large dense-cored vesicles of the nerve terminals. No immunoreactivity to substance P could be detected around sweat glands. In addition to these findings, the four types of immunoreactivity were seen in the thick preterminal nerve bundles.

Cytochemical localization of VIP-stimulated adenylate cyclase activity in human sweat glands.

Vasoactive intestinal polypeptide (VIP)-stimulated adenylate cyclase was demonstrated cytochemically in human sweat glands. Biopsies containing axillary sweat glands were incubated with 5 micron VIP and adenylate cyclase was demonstrated using the cerium-salt technique. Reaction products were localized in the plasma membranes of glandular and myoepithelial cells. Thus, VIP appears to stimulate adenylate cyclase activity without acetylcholine. VIP and acetylcholine in human sweat glands most probably act through a receptor complex, where adenylate cyclase is coupled to that part of the receptor stimulated by VIP.