Up-regulation of urinary UPIII mRNA levels in vesicoureteral reflux patients: Potential application as a screening test for vesicoureteral reflux

OBJECTIVES: Vesicoureteral reflux (VUR) is the most common congenital urinary tract anomaly. This disease can pose a major threat to the kidneys as twenty percent of patients with endstage renal disease are reported to have VUR. Although genetic studies for uroplakin III (UPIII) have been reported recently, no study has focused on UPIII gene expression in VUR patients. We describe here the up-regulation of UPIII mRNA in exfoliated urinary cells from primary VUR patients. METHODS: A real-time RT-PCR for UPIII mRNA was performed on exfoliated urothelial cells from 18 primary VUR and 38 control samples. UPIII mRNA copies were calculated for each sample. The statistical differences were assessed by the Mann-Whitney U test. Receiver operator characteristic curves were constructed for analysis of the diagnostic values. RESULTS: UPIII mRNA was found to be up-regulated to a greater extent in VUR than in control exfoliated urinary cells (mean +/- SE: 497.0 +/- 178.5 copies vs. 69.0 +/- 10.0 copies, respectively, P < 0.001). In evaluating the measurement of urinary UPIII mRNA as a screening test for VUR, the sensitivity was 77.8% and the specificity was 76.3% by the best diagnostic cutoff point. CONCLUSIONS: This is the first report demonstrating up-regulation of UPIII in mRNA levels in VUR patients. We submit that the quantitative measurement of urinary UPIII mRNA has a potential of developing into the first non-invasive screening test for VUR.     

Effects of Botulinum Toxin Type A on Contouring of the Lower Face

BACKGROUND: Masseteric muscle hypertrophy is an uncommon dition represented as a swelling of the masseter muscle. Recent reports have demonstrated the successful use of botulinum in the treatment of masseteric hypertrophy. OBJECTIVE: This study was a prospective trial to evaluate the effectiveness of botulinum toxin type A (Botox) in the treatment of masseteric muscle hypertrophy according to doses of 10, 20, and 30 U. MATERIALS AND METHODS: Twenty-two patients were referred to the dermatologic clinic for the management of masseteric muscle hypertrophy. Ultrasonographic measurements of the thickness of the masseter muscle were performed, and clinical photographs were taken before treatment and 1, 2, 3, 4, 6, and 9 months after the treatment. RESULTS. The median values of percentage reduction of muscle mass were 10.3%, 16.5%, 23.7%, 24.7%, 21.6%, 16.5% in the 10 U group; 11.9%, 18.8%, 24.8%, 27.7%, 26.7%, and 21.8% in the 20 U group; and 12.0%, 19.4%, 25.0%, 27.8%, 37.8%, and 24.1% in the 30 U group. CONCLUSION. The adequate dose of botulinum toxin type A for treatment of masseteric muscle hypertrophy should be above 20 U. The effect of botulinum toxin type A is maintained for at least 9 months as the treatment of masseteric muscle hypertrophy.     

Perioperative specific management of blood volume loss in craniosynostosis surgery

Accurate assessment and replacement of blood loss and fluid–electrolyte deficit during craniosynostosis repair is difficult owing to patient size and the diversity of surgical technique. Forty-three patients undergoing primary craniosynostosis repair over a 10-year period were studied retrospectively to determine blood loss and fluid deficit and to assess blood transfusion practices during both intraoperative and postoperative periods. Blood loss was calculated on the basis of estimated red cell mass (ERCM) and fluid-electrolyte imbalance was investigated with blood samplings. Blood transfusion was considered appropriate if the postoperative or posttransfusion ERCM was within 12% of the preoperative value. Estimated fluid requirement (EFR) was used in 4 ml kg^–1 h^–1 except for neonates. Intraoperatively, 80% of all patients were appropriately managed with respect to blood transfusion and EFR. Postoperatively only 20% of the patients receiving transfusions were transfused appropriately. In 23.3% of these patients (10/43) unexpected respiratory distress developed immediately after their recovery from the anesthesia. With the measurement of estimated blood volume and allowable blood loss, appropriate transfusion could be achieved for the successful treatment of the primary craniosynostosis. Received: 16 February 1998     

Preeclampsia and Chlamydia pneumoniae: is there a link?

Several parallels exist between preeclampsia and atherosclerosis. Both are multifactorial diseases that share risk factors such as obesity, insulin resistance, lipid abnormalities, and elevated serum homocysteine. There are also similarities in the biochemical changes seen in both diseases, including elevated serum triglycerides, decreased HDL cholesterol and enhanced formation of small, dense LDL particles as well as vascular atherosclerotic lesions. Chronic infection with Chlamydia pneumoniae has been linked to coronary artery disease. This study evaluated a possible link between the incidence of preeclampsia and infection with C. pneumoniae by examining the rate of seropositivity in 81 women with preeclampsia, and 206 women with normal pregnancies. Although our data confirmed well-known risk factors for preeclampsia such as obesity, diabetes, and hypertension, we found no difference in the rate of seropositivity between preeclampsia and normal pregnancy. On the contrary, the presence of chlamydial antibodies was lower in preeclampsia. Multiparous women with preeclampsia showed a significantly lower rate of seropositivity than multiparous normal women and nulliparous preeclamptics. In addition, women with a history of preeclampsia who developed preeclampsia in the current pregnancy also had a significantly lower rate of seropositivity.     

Impaired vagal heart rate control in coronary artery disease.

Heart rate variation in deep breathing, a sensitive non-invasive measure of cardiac parasympathetic activity, was measured in 63 patients with coronary artery disease, in 22 patients with atypical chest pain, and in 20 healthy symptom free volunteers. There was significantly less heart rate variation in deep breathing in the patients with coronary artery disease than in the healthy subjects. Twenty patients (32%) with coronary artery disease had lower than normal variation in heart rate. The patients with chest pain showed an intermediate heart rate response to deep breathing. Sinus arrhythmia in the patients with coronary artery disease was not related to the functional class, medication, number or location of narrowed vessels, or to the left ventricular ejection fraction, and end diastolic pressure. These results suggest that impairment of the parasympathetic nervous function is common in coronary artery disease.     

Alkaloidal components ofPanax ginseng

Over twelve alkaloids were delected in the roots ofPanax ginseng C.A. Meyer. Among them three alkaloids were isolated and were identified as N₉-formylharman, ethyl β-carboline-1-carboxylate and perlolyrine on the basis of spectroscopic studies.     

Cyclin E, p27 and mutant p53 do not predict the prognosis in AJCC stage II colorectal carcinomas.

BACKGROUND/AIMS: Carcinogenesis is characterized by the abnormal regulation of cell cycle. The abnormal expression of the regulators of cell cycle may be related to the prognosis. Since the clinical significance of the expression of the three proteins in colorectal carcinomas is still controversial, we evaluated the prognostic value of the expression of cyclin E, p27 and mutant p53 in stage II colorectal cancer. METHODS: The expression levels of cyclin E, p27 and mutant p53 proteins in 41 patients with stage II colorectal carcinomas were analyzed by immunohistochemistry. RESULTS: In the univariate analysis, the level of CEA at diagnosis was associated with disease relapse. In the multivariate analysis, the clinicopathological variables such as age, gender, site of primary tumor, tumor size, state of tumor differentiation and preoperative plasma CEA level were not associated with disease relapse. When Kaplan-Meier survival curves were constructed to determine the prognosis, cyclin E, p27 and mutant p53 expressions did not predict poor prognosis. CONCLUSIONS: Our results suggested that the expression of cyclin E, p27 and mutant p53 proteins did not predict the clinical outcome in the stage II colorectal carcinomas.     

Infracture Technique for the zygomatic body and arch reduction

In the Orient, prominent malar regions are considered unaesthetic and the majority of women with a prominent malar want to reduce the zygoma. Various operative procedures such as shaving or chiseling the zygomatic body or the zygomatic arch have been used for reducing malar eminence, but the zygomatic arch cannot be reduced sufficiently by these methods. By combining intraoral shaving of the zygomatic body and a new effect arch infracture technique through a temporopreauricular incision, we have obtained very satisfactory results in 19 cases and notable minimal complications over the last three years.