Comparison of parameters to determine the cause of urinary disturbance in men with prostate volume less than 20 milliliters

BACKGROUND: A pressure-flow study, although a slightly invasive procedure, can evaluate bladder outlet obstruction and detrusor contractility. This study was conducted in men with a non-enlarged prostate to determine the cause of urinary disturbance by less invasive examinations that might eventually replace pressure-flow study. METHODS: Thirty-six men with lower urinary tract symptoms were enrolled. Their prostate volume, estimated by transrectal ultrasonography, was less than 20 mL. All patients were examined using pressure-flow study, free-flowmetry, transrectal ultrasonography, prostate specific antigen and an interview using the International Prostate Symptom Score and Quality of Life Index. With determination of the cause for urinary disturbance, parameters that correlated with outflow obstruction or impaired detrusor contractility were sought. RESULTS: Twenty-one (60%) of the 36 men were judged as having outflow obstruction, and 16 of these 21 men had normal detrusor function. Impaired detrusor contractility was observed in 17 men. Only three of these 17 men had no outflow obstruction. Four patients had an unstable bladder. All these four had normal detrusor contractility, but had outflow obstruction. Among the parameters examined, only the maximum flow rate in a flow metrogram (Qmax) correlated significantly with the degree of outflow obstruction (P = 0.04). The positive predictive value of Qmax for outflow obstruction was 65% at a flow rate of less than 10 mL/s, and 100% at that of less than 5 mL/s. No parameter correlated with detrusor contractility. CONCLUSION: The only parameter that was a clear indicator of outflow obstruction was Qmax. Other indicators of detrusor contractility should be sought.     

Structure and Functions of Cell Surface Glycoconjugates in Brain Morphogenesis*

Abstract Migration of newly-generated neuroblasts to their definitive locations to form the laminated architecture of the brain is crucial in brain morphogenesis. In order to understand the molecular mechanism operative in the neuroblast migration, cell surface or pericellular glycoconjugates were isolated from the rat brains at various developmental stages. Hyaluronate (HA), chondroitin sulfate proteoglycans (CS-PGs), heparan sulfate proteoglycans (HS-PGs) and polysialosyl glycoproteins (N-CAMs) have been characterized so far. Our biochemical and immunohistochemical experiments indicate that HA and a CS-PG participate in construction of the hydrated extracellular milieu for the directional migration of neuroblasts. Dissociated fetal brain cells reaggregated and formed a tissue configuration, in aggregating culture for 48 h, similar to that observed in the original brain primordium. Therefore, one can consider that the in vitro process is regulated at least in part by the mechanism operative in brain morphogenesis in vivo. It was suggested that HS-PGs and N-CAMs were involved in the in vitro process of the tissue self-organization as cell membrane components. From these findings and others, we conclude that some developmental changes in the structure and the contents of these cell surface glycoconjugates of the brain are implicated in neuroblast migration in brain morphogenesis.     

Identification and Characterization of a Human Sperm Antigen Corresponding to Sperm-Immobilizing Antibodies

ABSTRACT: A sperm antigen has been isolated front radiolabeled human sperm cell membrane by detergent solubilization, lectin affinity chromatography, gel filtration, and indirect immune precipitation using sperm-immobilizing antisera from patients with unexplained infertility. Isolated material was characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Among 20 infertile women's sera with sperm-immobilizing antibodies, two were found to react predominantly with a sperm membrane polypeptide having the approximate molecular weight of 15,000 daltons. No significant binding to this molecule was observed in any sera from pregnant women, unmarried women, and normal men. By the absorption with spermatozoa, the antisera lost their binding activity to the molecule, while the sera absorbed with seminal plasma did not lose the activity. The results indicated that the molecule is a genuine sperm antigen and not a sperm-coating seminal plasma antigen. By the indirect immunofluorescence of washed ejaculated spermatozoa with the antisera, strong fluorescence was localized only in an equatorial segment of the acrosome, while no specific staining was observed in the controls. The antigen is relatively unstable against acid, alkali, and heat treatment. Treatment with proteolytic enzymes such as pronase and trypsin inactivated the antigen activity, indicating that the antigen epitope could be a peptide portion of the glycoprotein.     

The Effect of Maternal Antigenic Stimulation Upon the Active Immune Responsiveness of Their Offspring: Suppression Induced by Soluble Protein Antigen,Ovalbumin, in Mice

ABSTRACT: The active immune responsiveness of the offspring of pregnant mice stimulated with heterologous protein antigen was investigated by measuring the plaque-forming cells (PFC). Mice (C57BL/10;B10) immunized once in pregnancy with ovalbumin (OVA) in the form of Al(OH)3 gel (in alum) or in a soluble form (in saline) developed no anti-OVA PFC response. The anti-OVA PFC response suppression induced in the offspring was high in the offspring of alum-treated mothers and low in those of saline-treated mothers. The optimal dose of OVA in alum that induces the highest immunological memory in pregnant mice caused the complete suppression of PFC development in their offspring. The same dose of OVA in saline induced a negative immunological memory in pregnant mice and partial suppression in the offspring. On the other hand, mice primed prior to conception and boosted during pregnancy developed anti-OVA PFC in significant numbers, and only a partial suppression was established in their young. Based on these data, we discussed the possible mechanisms concerned with the specific suppression induced in the young B10 mice stimulated by OVA.     

Possible role for a polysaccharide antigen shared between Streptococcus pyogenes and S. mutans in the pathogenesis of poststreptococcal glomerulonephritis

Streptococcus mutans has been shown to share a polysaccharide (PS) antigen with S. pyogenes strains isolated from patients with acute poststreptococcal glomerulonephritis (PSGN), using a monoclonal antibody f-77 reactive with the PS.¹ To investigate the pathogenetic role of the shared PS in PSNG experimental nephritis was induced in animals. Rats were immunized thrice with heat-killed cells of S. mutans or S. pyogenes, followed by an intravenous injection of live cells of S. pyogenes. Histologic examination showed that both animal groups had comparable degrees of diffuse proliferative nephritis characterized by immune deposits. The shared PS antigen was detected in glomeruli of all nephritic rats by immunofluorescence using monoclonal antibody f-77. Furthermore, all nephritic rats had an elevated antibody titer to the shared PS antigen. These results suggest that prior sensitization (infections such as dental caries) to S. mutans modulates immune responses to subsequent S. pyogenes infections and induces immune-complex disease (PSGN) through the shared PS antigen.     

Application of percutaneous endoscopic gastrostojejunostomy in a case of amyotrophic lateral sclerosis associated with the superior mesenteric artery syndrome

A 64‐year‐old woman who was diagnosed as suffering from amyotrophic lateral sclerosis (ALS) of bulbar type was admitted to our hospital for long‐term care. After admission, she underwent percutaneus endoscopic gastrostomy (PEG) and enteral feeding was initiated. However, the PEG alimentation was disrupted by aspiration pneumonia owing to the superior mesenteric artery syndrome (SMAS), diagnosed by gross anatomy and endoscopic studies. Conservative treatment for SMAS was not successful and sepsis developed. After recovery from this, an operation was recommended, but it was rejected by her and her family members. We therefore selected the method of placing a thin jejunostomy tube through the PEG, called percutaneous endoscopic gastrojejunostomy (PEGJ) and pulling it endoscopically into the proximal jejunum, thereby allowing delivery of nutrients. Thereafter, she was well and showed gradual improvement of nutritional parameters such as serum albumin and total cholesterol, as well as the lymphocyte subset. It is concluded that PEGJ is effective for long‐term enteral nutrition in ALS patients complicated with SMAS.