Effect of intravesical nitric oxide therapy on cyclophosphamide-induced cystitis

PURPOSE: This study was conducted to examine effects of nitric oxide (NO) donors on bladder hyperactivity induced by cyclophosphamide (CYP)-induced cystitis. MATERIALS AND METHODS: Female Sprague-Dawley rats received a single intraperitoneal injection of CYP (100 mg./kg.), and then their micturition pattern including mean micturition volume and the number of micturitions during 24 hours was recorded in a metabolic cage before and after CYP treatment. Forty-eight hours after CYP injection, bladder function under urethane anesthesia was evaluated by cystometry with continuous saline infusion (0.04 ml. per minute) or under isovolumetric conditions (0.8 ml. bladder volume). NO donors, S-nitroso-N-acetyl-penicillamine (SNAP, 2 mM) or sodium nitroprusside (SNP, 1 mM), and an NO synthase (NOS) inhibitor, N-nitro-L-arginine methyl ester (L-NAME, 20 mM) were administered intravesically. Direct action of SNAP on bladder afferent neurons was also tested in a patch-clamp recording study. RESULTS: The number of micturitions significantly increased during the first 24 hours after CYP injection (19.0 +/- 0.88 versus 92.1 +/- 16.3 micturitions/24 hours, mean +/- SE, n = 25) (p <0.001). There was no significant difference in total micturition volume before (12.3 +/- 1.0 ml./24 hours) and after CYP treatment (15.6 +/- 1.5 ml./24 hours). During continuous infusion cystometry, intercontraction interval (ICI) was smaller in CYP-injected rats than in control rats. In CYP-injected animals, NO donors increased the ICI, but did not change the amplitude of bladder contractions. Continuous intravesical infusion of the NOS inhibitor did not alter the cystometric parameters. During cystometry under isovolumetric conditions, contraction frequency was decreased after NO donor administration. NO donors did not influence bladder activity in control rats. In patch clamp recordings, when SNAP (500 microM) was directly applied to dissociated afferent neurons innervating the urinary bladder, high-voltage-activated Ca2+ channel currents were suppressed by approximately 30%. CONCLUSIONS: Intravesical NO donors can suppress CYP-induced bladder hyperactivity. We hypothesize that the effect of NO donors is not due to smooth muscle relaxation, but rather due to an inhibitory effect on bladder afferent pathways that was manifested by an increase in intercontraction interval without changes in contraction amplitude. NO donors may be considered as a possible treatment of CYP-induced and other types of bladder inflammation.     

Aneurysm of persistent primitive hypoglossal artery

A patient with a ruptured intracranial aneurysm of the right persistent primitive hypoglossal artery is described. Clipping of the aneurysmal neck was achieved by a far lateral approach together with drilling of the jugular tubercle, and it was concluded that this approach should be followed for safe and complete clipping.     

Post-traumatic pituitary apoplexy--two case reports

A 60-year-old female and a 66-year-old male presented with post-traumatic pituitary apoplexy associated with clinically asymptomatic pituitary macroadenoma manifesting as severe visual disturbance that had not developed immediately after the head injury. Skull radiography showed a unilateral linear occipital fracture. Magnetic resonance imaging revealed pituitary tumor with dumbbell-shaped suprasellar extension and fresh intratumoral hemorrhage. Transsphenoidal surgery was performed in the first patient, and the visual disturbance subsided. Decompressive craniectomy was performed in the second patient to treat brain contusion and part of the tumor was removed to decompress the optic nerves. The mechanism of post-traumatic pituitary apoplexy may occur as follows. The intrasellar part of the tumor is fixed by the bony structure forming the sella, and the suprasellar part is free to move, so a rotational force acting on the occipital region on one side will create a shearing strain between the intra- and suprasellar part of the tumor, resulting in pituitary apoplexy. Recovery of visual function, no matter how severely impaired, can be expected if an emergency operation is performed to decompress the optic nerves. Transsphenoidal surgery is the most advantageous procedure, as even partial removal of the tumor may be adequate to decompress the optic nerves in the acute stage. Staged transsphenoidal surgery is indicated to achieve total removal later.     

Multiple chemical sensitivities: case definition, etiology and relations to allergy, poisoning, psychogenic illness etc]

Multiple Chemical Sensitivities (MCS) have been defined as an acquired disorder characterized by recurrent symptoms, referable to multiple organ systems, occurring in response to demonstrable exposure to many chemically unrelated compounds at doses far below those established in the general population to cause harmful effects; no single widely accepted test of physiologic function can be shown to correlate with symptoms (Cullen MR, 1987). The etiology of MCS is hypothesized as a toxicant-induced loss of tolerance to multiple chemicals with subsequent manifestation of multiple-organ symptoms triggered by low-level exposure to such chemicals. The involvement of multiple organs might be attributed to a neurogenic switching mechanism. The final diagnosis of MCS is to rely on provocation of symptoms in a exposure chamber by a double-blind method. Relations of MCS to allergy, poisoning, psychogenic illness, chemical sensitivity, idiopathic environmental intolerances etc. are discussed in terms of case definition and etiology of these disorders.     

Pharmacological review of tropisetron

Tropisetron is used as an anti-emetic agent against chemotherapy-induced nausea and vomiting. Tropisetron shows strong 5-HT3 antagonist and weak 5-HT4 antagonist activities in vitro. In the various animal models of vomiting including chemotherapy- or radiotherapy-induced emesis in the dog and ferret, tropisetron is reported to inhibit the emetic episodes. The potent anti-emetic activity of oral tropisetron rather than the i.p. administered drug suggests that it can act directly from the intestinal lumen as well as from the blood stream after its absorption. Moreover, the anti-emetic activity of tropisetron may involve the 5-HT4-receptor mechanism in addition to the 5-HT3-receptor mechanism. Tropisetron has several pharmacological activities other than anti-emesis such as the stimulation of the gastric emptying and the inhibition of the diarrhea, visceral pain and anxiety. These effects of tropisetron may contribute to the high clinical efficacy of tropisetron against chemotherapy-induced emesis.     

Localization of B2 bradykinin receptor mRNA in the rat retina and sclerocornea

The expression of the B2 bradykinin receptor (BKR) mRNA in the adult rat eye was investigated by RNA blot and in situ hybridization analyses. Blot hybridization analysis of poly(A)+ RNA from the whole eye identified RNA species of 6000 and 4000 nucleotides, consistent with those observed in brain, lung, kidney and uterus. In situ hybridization analysis using digoxigenin-labeled riboprobes revealed intense labeling in the retinal ganglion cell layer and in a population of cells adjacent to the sclerocorneal junction. These data suggest that the B2 BKR is involved in biological processes in both retina and sclerocornea.     

Extrarenal Wilms' tumour

Extrarenal Wilms' tumour is rare and its imaging has received scant mention in the literature. We describe a 2-year-old boy with a firm mass in the right flank. CT, MRI and ultrasonography showed an inhomogeneous solid mass located in the retroperitoneum, which was separate from the right kidney. Angiography showed an enlarged right gonadal artery and irregularly tortuous vessels in the tumour similar to intrarenal Wilms' tumour (spider leg or creeping vine appearance). Histopathological examination confirmed an extrarenal Wilms' tumour.     

Repetitive speech disorder resulting from infarcts in the paramedian thalami and midbrain.

A repetitive speech disorder resulting from infarcts in the paramedian thalami and the midbrain is reported. Although the speech disorder seemed like stuttering, the compulsive repetitions, constant rate and monotonous tone were not associated with ordinary stuttering. Since repetition was restricted to the first syllable, the speech disorder in our patient could be distinguished from palilalia. The extrapyramidal system is considered responsible for repetitive speech disorders resulting from infarcts in the paramedian thalami and the midbrain but without good reason. Repetitive speech disorder in patients with infarcts in the supplementary motor area (SMA) have similar clinical features to our patient. It is suggested that interruption in the projective system to the SMA is a possible cause of "stuttering like repetition".     

A Double-Blind Controlled Study of Clinical Efficacy of Maprotiline and Amitriptyline in Depression

A multiclinic double-blind controlled study was performed on the effects of MAP in both inpatients and outpatients with AMT as control drug.

• 1 Subjects consisted of 41 male and 45 female patients suffering from various types of depression. MAP was assigned to 42 cases and AMT to 44 cases. Of these patients, 14 MAP cases and 10 AMT cases were subsequently dropped for a variety of reasons to obtain 28 MAP cases and 34 AMT cases as evaluable.
• 2 The global improvement ratings were compared and found not significantly different for any week between the two treatments.
• 3 The global improvement ratings by the characteristic features of patients did not show any significant difference in any items studied between the two treatments.
• 4 The symptomatic improvement ratings (on the Hamilton R.S. for assessment by the physician) indicated that AMT was more effective on “anxiety (psychic).”
• 5 The symptomatic improvement ratings (on the Beck self-assessment scale by the patient) indicated that MAP was more effective on “work” and AMT on “pathos”, “feeling of satisfaction”, “withdrawal” and “loss of libido.”
• 6 During the treatment period, 74.3 percent of the MAP group and 76.9 percent of the AMT group of patients showed some side effects or accompanying symptoms, with no significant difference recognized between the two treatments. Itemwise, however, the incidence of tremor was significantly lower (p-=0.06) in the MAP group. Moreover, the MAP group tended to be less liable to such anti-cholinergic side effects as dry mouth, constipation, trouble of accommodation, urinary disturbance and palpitation.
• 7 On the basis of the above findings, it is concluded that MAP is as effective against depression as AMT and less liable to the anticholinergic side effects. It is, therefore, a very useful antidepressant.