Intravesical tape erosion following the tension-free vaginal tape procedure for stress urinary incontinence

We report a case of intravesical tape erosion which occurred 6 months after the tension-free vaginal tape (TVT) procedure, which was successfully treated by partial tape removal. A 75-year-old woman, who had complained of recurrent cystitis after TVT procedure, was referred to Kobe City General Hospital in August 2003. The intravesical tape erosion was revealed by cystoscopy and computed tomography, and the tape was removed with a retropubic approach. The recurrent cystitis has been cured and the stress urinary incontinence has not recurred. The intravesical tape erosion was rare, with only seven reported cases including the present case.     

Three-year follow-up study of allergy in workers in a mushroom factory

Exposure to mushroom spores may cause many respiratory allergic diseases, however, there has been no serial study in a mushroom factory to address this problem. The aim of this study was to investigate the serial changes in respiratory allergy and the incidence of hypersensitivity pneumonitis (HP) in mushroom workers. A 3-year follow-up study, beginning in June 1996, was conducted in a newly operating mushroom factory in which one kind of mushroom is produced: Hypsizigus marmoreus (Bunashimeji). Allergic symptoms, chest roentgenogram, serum precipitins to the spores and soluble adhesion molecules in sera were evaluated once a year in 60 workers and 20 controls. Three out of the 60 subjects were diagnosed as having HP caused by inhalation ofthe mushroom spore and they were therefore excluded from this study, and the 57 non-HP subjects were evaluated. In this study 24 workers quit because of intolerable cough, runny nose, wheezing, sputum, fever elevation and/or shortness of breath at their place of work. During each year of this study as many as 70-80% of employees suffered some ofthe above symptoms, cough being the most frequent, and positive rate of serum precipitins to the spore revealed 30% in 1996, 93% in 1997 and 94% in 1998. From the June 1996 examination until the following May, serum soluble intercellular adhesion molecule-1 levels of the 15 workers who quit during that period were significantly higher than those in the 42 workers still employed in 1997 (P < 0.05). Workers in Bunashimeji mushroom factories might be at critical risk of developing respiratory allergy. In our 3-year study over 90% workers were sensitized to the spore, 40% quit because of the symptoms and 5% developed HP. It was suggested that workers should be counselled about the risk of mushroom allergy and precautionary measures should be taken to prevent its occurrence.     

The Mechanism of Excretion of Trientine from the Rat Kidney: Trientine is not Recognized by the H+/Organic Cation Transporter

Trientine dihydrochloride is used to treat Wilson's disease by chelating copper and increasing its urinary excretion. The mechanism of renal excretion of trientine has been investigated in-vivo and in-vitro. Trientine clearance in the rat was significantly faster than creatinine clearance. When trientine and the same number of moles of copper ions were administered simultaneously to the rat, however, trientine clearance decreased to almost the same level as the creatinine clearance. To clarify this active excretion system for trientine, the uptake of trientine and a physiological polyamine compound, spermine, was investigated using rat renal brush-border membrane vesicles. Although, because trientine and spermine are organic cations, the H+/organic cation transporter is expected to recognize these compounds, neither an outwardly directed H+ gradient nor an inward Na+ gradient stimulated trientine uptake. [¹⁴C]Spermine uptake was, nevertheless, trans-stimulated by both unlabelled spermine and trientine and the trans-stimulating effect of spermine on trientine uptake was, furthermore, completely abolished by addition of copper ions to the incubation medium. These results suggest that there is a specific transport system for spermine and trientine on the renal brush-border membrane. This transport system contributes to the secretion of trientine in the kidney proximal tubule but does not recognize the trientine-copper complex.     

Chrome congestive heart failure: Activation and destruction of platelets in patients with rheumatic heart disease

We evaluated the activation and destruction of platelets in24 patients with rheumatic heart disease (RHD) involving themitral valve. Ex vivo platelet aggregation induced by adenosinediphosphate (ADP) and collagen was significantly increased inRHD patients as compared with normal controls. Plasma levelsof ß-thromboglobulin (ß-TG) and plateletfactor 4 were also elevated Plasma concentrations of glycocalicin,a proteolytic fragment of platelet membrane glycoprotein Ib.were increased, while platelet counts were decreased in RHDpatients as compared with normal controls. RHD patients with,versus those without, atrial fibrillation demonstrated significantdifferences in ß-TG levels and platelet counts. However,we observed no difference in glycocalicin levels between thetwo groups. The present study demonstrated that increased plateletactivation, as well as platelet destruction, occur in patientswith RHD.     

Intrahepatic expression of HBsAg and HBcAg in asymptomatic HBsAg carriers and its follow-up

Intrahepatic expression of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) was investigated in 46 asymptomatic HBsAg carriers by a direct immuno-fluorescent method. In 21 HBeAg positive carriers, HBsAg was expressed diffusely on the membrane of hepatocytes, with associated cytoplasmic localization in a few scattered hepato-cytes. HBcAg was expressed in the nucleus of many hepatocytes and in the cytoplasm of a few scattered hepatocytes, but not on the cell membrane. In 25 anti-HBe positive carriers, HBsAg was expressed on the surface and in the cytoplasm of hepatocytes diffusely and/or focally, but neither intrahepatic HBcAg nor serum HBV-DNA was detected. Repeat liver biopsies were performed in 17 patients. In eight of 13 HBeAg-positive HBsAg carriers, who developed histologically proven chronic hepatitis and liver cirrhosis, the localization of HBsAg in liver had changed from a membranous to a mixed (membrane and cytoplasm) pattern, and localization of HBcAg in liver had changed from a predominantly nuclear to a predominantly membranous and cytoplasmic pattern. However, in two HBeAg and two anti-HBe positive cases who showed no biochemical and histologic change at follow-up, the intrahepatic expressions of HBsAg and HBcAg in the second biopsies remained unchanged. Thus, decrease in membranous expression of HBsAg and increase in membranous and cytoplasmic expression of HBcAg were associated with progression to chronic liver disease. This suggests that membranous HBcAg may represent the major target in the process of injury to hepatocytes.     

Impact of radical perineal prostatectomy on urinary continence and quality of life: A longitudinal study of Japanese patients

AIM: We used self-completed questionnaires to obtain a longitudinal assessment of urinary continence and urinary, bowel, and sexual domain-related quality of life (QOL) in Japanese patients undergoing radical perineal prostatectomy (RPP). METHODS: A total of 41 Japanese patients with a median age of 69 years who underwent RPP between February 2002 and February 2004 were included in the study. We measured QOL by the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and assessed urinary continence on the basis of three different definitions of continence. The International Prostate Symptom Score (I-PSS) was also included to evaluate lower urinary tract symptoms (LUTS). RESULTS: When urinary continence was de fi ned as none, one, or two protective pads per day, 100%, 73%, 94%, 97%, or 100% of the patients were continent before, and 1, 3, 6, and 12 months after, RPP, respectively. When it was de fi ned as total control or occasional dribbling, the corresponding values were 97%, 70%, 84%, 94%, and 97%. Urinary function returned to the preoperative baseline level by 6 months postoperatively and scores for urinary bother had significantly surpassed the baseline by 12 months (P = 0.043). The I-PSS was significantly improved (P = 0.014), with a mean 4.7-unit decrease. Sexual function worsened significantly after surgery, and its recovery was less favorable. No significant change was observed in scores for bowel function or bowel bother. CONCLUSIONS: The majority of patients who undergo RPP rapidly regain urinary continence and QOL within 3-6 months. RPP has a favorable impact on LUTS.     

Failure to detect urethral Trichomonas vaginalis in Japanese men with or without urethritis

AIM: Trichomonas vaginalis may cause symptomatic or asymptomatic urethritis in men. There are few recent studies on the prevalence of T. vaginalis infection in Japanese men, and quantification of the number of cases of urethritis attributable to this pathogen has not been performed in Japan. The aim of this study was to determine the prevalence and morbidity of T. vaginalis infection in Japanese men. METHODS: One hundred subjects with or without urethritis were examined for the presence of urethral T. vaginalis using culture swabs. RESULTS: Urethral swabs from all subjects were negative for T. vaginalis. CONCLUSION: These results indicate Japanese men, including those with urethritis, have a low incidence of urethral T. vaginalis infection or colonization. T. vaginalis appears to be an uncommon pathogen for male urethritis in Japan.     

Probucol inhibits intercellular adhesion molecule-1 expression on cultured rat mesangial cells

Interleukin-1 (IL-1) has been reported to participate in the progression of glomerulonephritis by, in part, up-regulating intercellular adhesion molecule-1 (ICAM-1) expression in experimental glomerulonephritis. In the present study, we examined whether probucol, an antihyperlipidemic agent, inhibited IL-1-induced inflammatory processes in mesangial cells in culture. Northern blot analysis demonstrated that 200 U/mL IL-1 up-regulated ICAM-1 messenger RNA (mRNA) expression with its peak at 4–6 h after stimulation. Ten μg/mL lipopolysaccharide (LPS), a stimulant to release IL-1 from mesangial cells, induced ICAM-1 mRNA expression by five-fold within 6 h and 10 μg/mL probucol notably reduced this induction. Immunoblotting also confirmed that LPS increased ICAM-1 protein by two-fold within 24 h and probucol inhibited this increase. IL-1 receptor antagonist (IL-1ra; 1–100 ng/mL) suppressed LPS-induced ICAM-1 mRNA expression in a dose-dependent manner and 100 ng/mL IL-1ra completely inhibited ICAM-1 induction, indicating that LPS increased ICAM-1 expression through the action of secreted IL-1. Interleukin-1 activity in culture media, measured by thymocyte proliferation assay, was significantly enhanced by LPS and inhibited by probucol. However, neither LPS nor probucol substantially affected IL-1 mRNA expression, suggesting that the IL-1 activity might be regulated at post-translational level. These results suggest that probucol may act as an anti-inflammatory drug by suppressing IL-1 activity from mesangial cells in the progression of glomerulonephritis.