Case Report: Tetraploid Leukemia

A patient with acute leukemia andtetraploid blast cells in the bone marrowis reported. The patient was a 69-yr-oldwhite male who was referred to ourinstitution for chemotherapy. His bonemarrow contained 89% blasts, 30% ofwhich were peroxidase positive. Theclinical history was characterized by arapid, downhill course, and the patientexpired 1 mo after admission in spite ofchemotherapy. At autopsy, nests of viableleukemic cells were still present in thebone marrow. Cytogenetic studies demonstrated a true tetraploid karyotypewith 92 chromosomes. The various mechanisms that may lead to the establishment of a tetraploid clone and theclinical implications of the presence ofthese cells in acute leukemia are discussed. So far as we know, this is thefirst case in which a true tetraploid cloneassociated with human neoplasia hasbeen identified.

Submitted on May 3, 1971 Revised on June 9, 1971 Accepted on June 10, 1971     

Carcinoma of the Esophagogastric Junction

We have reviewed and analyzed the clinical and radiographic features of 38 patients with proven carcinoma involving the esophagogastric junction. There were 29 cases of adenocarcinoma and nine of squamous cell carcinoma presenting with similar symptoms, surgical findings and radiographic characteristics. Features that suggest adenocarcinoma are: I. mass or distortion of the gastric fundus: 2. short lesion; 3. smooth submucosal contour defect representing tumor undermining mucosa. Hiatus hernia was present in 17% of adenocarcinomas and 44% of epider-moid carcinomas but the association appears to be coincidental. Atypical forms of presentation such as lesions involving almost the entire esophagus or mimicking peptic esophagitis and achalasia are discussed and illustrated. Pertinent data from the literature is reviewed. In order to avoid errors in the roentgenographic diagnosis routine careful examination of the esophagogastric Junction is recommended.     

ERECTILE RESPONSE TO TRANSURETHRAL ALPROSTADIL, PRAZOSIN AND ALPROSTADIL-PRAZOSIN COMBINATIONS

Purpose

Transurethral alprostadil has been shown to be efficacious in many men with erectile dysfunction. We compared transurethral alprostadil and prazosin alone, and in combination to treat this disorder.

Materials and Methods

In this double-blind, placebo controlled study the erectile responses to transurethral alprostadil, prazosin and alprostadil-prazosin combinations were assessed in 234 men 26.8 to 8.15 years old with complete organic erectile dysfunction. Patients self-administered a random sequence of 7 doses in the clinic in 4 weeks. The erectile response was assessed using categorical and visual analog scales.

Results

Full penile enlargement or rigidity was achieved by 165 of the 234 men (70.5%) after at least 1 active dose of medication. The most effective alprostadil dose (500 micro g.) resulted in full penile enlargement or rigidity in 51.8% of administrations, whereas the most effective prazosin dose (2,000 micro g.) and placebo resulted in a similar response in 12.7 and 2.7%, respectively (p <0.001). The 500/2,000 micro g. alprostadil/prazosin combination, which resulted in full enlargement or rigidity in 58.9% of doses, was only slightly better than the most effective dose of alprostadil alone (500 micro g.). However, combinations of 125/500 and 250/500 micro g. alprostadil/prazosin were more effective (p <0.01) than 125 and 250 micro g. alprostadil given alone, respectively. The most common side effect of therapy was penile pain, which rarely led to study discontinuation. Hypotension most commonly developed at the higher alprostadil-prazosin combination.

Conclusions

Transurethral alprostadil and alprostadil-prazosin combinations produced erections in men with complete organic erectile dysfunction. This combination therapy may be an option in patients who do not respond to transurethral alprostadil alone.     

IN VITRO FUNCTIONAL PROPERTIES OF THE RAT BLADDER REGENERATED BY THE BLADDER ACELLULAR MATRIX GRAFT

Purpose

To assess the response of rat urinary bladder regenerated by the homologous bladder acellular matrix graft (BAMG) to in vitro electrical and pharmacologic stimuli.

Materials and Methods

In Sprague-Dawley rats, partial cystectomy (>50%) was performed, followed by BAMG augmentation cystoplasty. After 4 months, organ bath studies of tissue strips in 10 were used to compare the contractility of the BAMG regenerates and the corresponding host detrusor smooth muscle.

Results

The BAMG regenerates exhibited contractile activity to electrical field stimulation and a qualitatively identical pattern of response to muscarinic, purinergic, alpha- and beta-adrenergic drug administration and nitric oxide. At 4 months after surgery, the maximum forces of contraction of the BAMG regenerates to carbachol stimulation amounted to close to 80% of the host bladder response. With electrical field stimulation, they equaled 44% and 62% of the host bladder response after 2.5 and 4 months, respectively. Histological and immunohistochemical studies confirmed the presence of receptors for neurotransmitters that these functional in vitro studies implied.

Conclusions

The present study provides further evidence that augmentation cystoplasty with the BAMG leads to functional regeneration of the rat bladder detrusor smooth muscle.     

Structure-activity relationships for some elastin-derived peptide chemoattractants

In an attempt to explore the relationships between conformation of chemotactic peptides related to elastin and their biological activity we have studied five peptides: VGVAPG, VGVPG, VGAPG, GVAPG and GGVPG in solvents of different polarities which may mimic the environmental conditions at the receptor site. CD and NMR studies showed that GVAPG has no preference for structured conformations, while the other peptides may assume folded conformations in organic solvents. All these peptides but GGVPG showed chemotactic activity for monocytes. The chemotactic activity of VGVPG, VGAPG and VGVAPG was inhibited by lactose, while chemotaxis of peptide GVAPG was insensitive to lactose, suggesting the existence of different chemotactic receptors.     

LONG-TERM RESULTS OF COLPOCYSTOURETHROPEXY FOR PERSISTENT OR RECURRENT STRESS URINARY INCONTINENCE

PURPOSE: We review the long-term outcome of colpocystourethropexy for persistent or recurrent stress urinary incontinence after suspension procedure failure. MATERIALS AND METHODS: Medical records and preoperative studies were reviewed of 60 patients (mean age 60.8 years) who had undergone colpocystourethropexy after at least 1 suspension procedure (range 1 to 8, mean 2.7). Patient responses to a standardized questionnaire regarding overall health, degree of satisfaction with colpocystourethropexy, presence or absence of leakage, and pattern and degree of leakage were elicited by telephone or mail and compared with preoperative status. Results were graded according to the degree of satisfaction and number of pads used daily. Patients with persistent incontinence were reevaluated with video urodynamic studies. RESULTS: Mean interval since colpocystourethropexy was 6.9 years. Successful results (greater than 80% satisfaction and the use of 1 or no pad daily) were reported by 41 patients (69%), who were significantly younger at the time of surgery than those with unsatisfactory results. In the latter group significant urge incontinence was present in 61% before the repair and in 63% postoperatively, suggesting an additional nonanatomical cause, which was confirmed by postoperative video urodynamic studies. CONCLUSIONS: When colpocystourethropexy was used for persistent urinary incontinence after previous surgical repair two-thirds of the patients had excellent long-term results. In patients with less satisfactory results a nonanatomical cause of urinary incontinence was a major factor.