Extensive biopsy using a combined transperineal and transrectal approach to improve prostate cancer detection

PURPOSE: Previous studies have indicated that 6-core transrectal prostate biopsy misses a considerable number of cancers. We performed an extensive biopsy protocol of 12-core sampling using both transperineal and transrectal approaches to determine the impact on the cancer detection rate. MATERIALS AND METHODS: We prospectively evaluated 402 men who underwent 6-core transperineal and 6-core transrectal biopsies simultaneously due to abnormal digital rectal examination (DRE) and/or elevated prostate-specific antigen (PSA) levels of 4.0 ng/mL or greater. Using the transperineal approach we obtained four cores from the bilateral peripheral zone targeting the lateral and parasagittal areas and two cores from the bilateral transition zone. The following transrectal biopsy was performed traditionally. We compared cancer detection rate between the extended 12-core procedure and conventional 6-core transperineal and transrectal groups in terms of total PSA and DRE findings. RESULTS: Using the extensive combined method, prostate cancer was detected in 195 cases (48.5%) and the detection rate significantly increased 7.2% and 8.5% compared to the transperineal and transrectal groups, respectively. According to PSA levels and DRE findings, the cancer detection rate by the combined method was significantly improved in patients with PSA levels of 4-10 ng/mL and negative DRE: 10.3% and 11.6% compared to the transperineal and transrectal groups, respectively. CONCLUSIONS: The extensive 12-core method significantly improved the overall cancer detection rate and was especially efficient for men with PSA levels of 4-10 ng/mL accompanied by a negative DRE finding.     

Bacterial changes in neonatal intensive care unit

Organisms routinely cultured from throat swabs and infectious agents of sepsis and/or meningitis were reviewed. During the last 12 years, Klebsiella pneumoniae and Escherichia coli have been replaced by Staphylococcus aureus and Pseudomonas aeruginosa as the predominant isolates from throat swabs after admission. These change in the etiologic pattern of infectious agents of sepsis and/or meningitis, i.e., K. pneumoniae, E. coli, S. aureus, P. aeruginosa and staphylococcus epidermidis, were in agreement with the organisms isolated from the throat swabs after admission. The S. aureus isolated from throat swabs after admission showed a decrease in the bacterial activity of cloxacillin, cephazolin and cefotaxime since 1978.     

Prediction of transfusions in extremely low-birthweight infants in the erythropoietin era

BACKGROUND: The purpose of the present paper was to detect the clinical factors most predictive of red blood cell (RBC) transfusion in extremely low-birthweight (ELBW) infants in the recombinant human erythropoietin era. METHODS: Between 1995 and 2000, 66 ELBW infants were admitted to a level III neonatal intensive care unit. Fifty-four of 66 infants were eligible for enrollment in the present study. Infants were treated with erythropoietin 200 IU/kg per dose s.c. twice a week with 4-6 mg/kg per day iron supplement. RESULTS: The mean gestational age and birthweight were 26.5 +/- 2.1 weeks and 776 +/- 134 g, respectively. Ten of 54 ELBW infants (18.5%) died during the first 21 days. Eight of 10 dead infants (80.0%) and 27 of 44 surviving infants (61.4%) received one or more RBC transfusions. The overall requirement for RBC transfusions in the surviving infants was 3.0 +/- 3.2 per infant/hospital course (range: 0-9) . There were significant differences in gestational weeks, birthweight, initial hemoglobin value, 5 min Apgar score, phlebotomy loss, phlebotomy loss/birthweight, duration of mechanical ventilation, duration of oxygen supplement, and incidence of both intraventricular hemorrhage and chronic lung disease between the transfused and non-transfused group. The predictive variables, initial hemoglobin level (odds ratio [OR] 2.61; 1 g/dL), birthweight (OR 3.00; 100 g), and gestational week (OR 1.89; 1 week), were found to be most predictive for transfusion on logistic regression analysis. CONCLUSION: ELBW infants are still the population at greatest risk for repeated blood transfusions after introduction of erythropoietin treatment. If labor develops, it is often impossible to extend the pregnancy period, therefore efforts should be made to increase hemoglobin level at birth.     

MEDIAN RAPHE (PARAMEATAL) CYSTS OF THE PENIS

Purpose

Although median raphe cysts of the penis have been widely reported the pathogenesis is obscure. We describe the microstructural detection of 3 cases of median raphe to study the true pathogenesis.

Materials and Methods

Three patients presented to our clinic of plastic surgery complaining of abnormal shape of the penis or mass recurrence. High magnification light microscopy and electron microscopy were performed.

Results

Microstructural study revealed that all 3 cases had similar findings to those of the common urethral mucosa.

Conclusions

Median raphe cysts are derived from the external paraurethral ducts and contain features that to our knowledge have not been previously reported.     

SUSCEPTIBILITY TO IDIOPATHIC AZOOSPERMIA IN JAPANESE MEN IS LINKED TO HLA CLASS I ANTIGEN

Purpose

Approximately 15 to 20% of infertile men have azoospermia. In the Y chromosome a deletion, termed the azoospermic factor, has been found in some cases of idiopathic azoospermia. We investigate the relationship of factors in autosomal chromosomes (HLA class I antigens) to spermatogenesis failure in idiopathic azoospermia.

Materials and Methods

We evaluated 65 infertile Japanese men with idiopathic azoospermia. The frequency of the HLA allele reported in 1,216 healthy Japanese men was used as a control. HLA class I typing was performed by the National Institutes of Health standard serological method or polymerase chain reaction-sequence specific primer analysis. Allele frequencies were calculated. We determined statistical significance in the frequency of each allele in patients and controls using the chi-square test. The relationship of HLA antigens to idiopathic azoospermia was expressed as relative risk.

Results

In Japanese men with idiopathic azoospermia the frequency of HLA-A33, B13 and B44 was significantly increased compared with controls. The relative risk of HLA-B44 was 8.4, an extremely high value compared with that of other diseases and HLA antigens.

Conclusions

We suggest that HLA class I antigens are important genetic markers that represent a risk factor for idiopathic azoospermia.     

Effects of exercise for 1 month on serum lipids in adolescent females

BACKGROUND: The present study was done to clarify the effects of 1 month of exercise on levels of total cholesterol (TC) and high-density lipoprotein cholesterol (HDLC) and on the ratio TC/HDLC and also to evaluate the relationship of body fat to amount of exercise and TC/HDLC ratio. METHODS: Twenty-seven female athletes (aged 15-18 years) were divided into two groups: the participant's group, in which players trained and attended a tournament, and the non-participant's group, in which players did not attend the tournament. We assessed the amount of exercise, body composition, serum TC and HDLC and TC/HDLC on four occasions: before (T0), during (T1), 1 day after (T2) and a week after (T3) the experimental period. Levels of TC and HDLC adjusted for changes in plasma volume were compared for each occasion. Two multiple regression models for change in TC/HDLC from T0 to T2 and from T0 to T3 were employed. RESULTS: (i) The changing patterns in TC and HDLC throughout the program were different between the two groups; (ii) the decreased level of TC/HDLC after 1 month of exercise may easily revert to its original level; and (iii) the relevant factor for the decline in TC/HDLC was the amount of exercise, not body fat reduction. CONCLUSIONS: Exercise may be a more important factor for the improvement of TC/HDLC than concomitant body fat reduction and non-strenuous exercise may maintain a more stable and higher HDLC level than strenuous exercise.     

Isolation of a Kawasaki disease-associated bacterial sequence from peripheral blood leukocytes

BACKGROUND: The clinical and epidemiologic features of Kawasaki disease (KD) suggest an infectious etiology, but the agent(s) remains unknown. We aimed to isolate the causative bacterial gene from peripheral blood leukocytes of patients with acute KD. METHODS: Nested polymerase chain reaction (PCR) assay was used to amplify the bacterial 16S ribosomal RNA gene (rDNA). The amplified DNA were cloned into a plasmid vector and sequenced. Phylogenetic analysis was performed with clustal W program and the neighbour-joining method. RESULTS: First, the PCR reagents were examined by the PCR assay using conservative primers and we found more than 10 16S rDNA sequences contaminating the reagents. We then examined five KD patients using the PCR assay, excluding the contaminated sequences, and obtained five 16S rDNA sequences as possible KD-associated sequences. The primers specific to each 16S rDNA sequence were synthesized and used for specific PCR assays. Only the PCR assay specific to the 16S rDNA sequence termed 16S71-33 did not show any false positives with the control DNA from non-KD patients. The 16S71-33 sequence was positive in three of 20 patients with acute KD before gamma-globulin therapy, but it became negative after therapy. The phylogenetic analysis showed a new species of the genus Corynebacterium as the origin of the 16S71-33 sequence. CONCLUSIONS: These data show that an infectious KD agent is traced in peripheral leukocytes and that a new Corynebacterium species may be responsible for KD in some cases. The true frequency and the role of the new Corynebacterium in KD would be clarified by measuring specific antibodies to it.     

Somatization in adolescence with reference to dysmorphophobia

Abstract An adolescent male obtained a position in a large business with assistance from others. Initially he had tension headaches due to maladjustment. He then showed signs of dysmorphophobic symptoms, expressed as a dissatisfaction with his nose. Subsequently, he had cosmetic rhinoplasty twice for esthetic reasons. After a few years, he presented with a psychosis. During treatment his symptoms developed into headache and fever that disappeared upon recovery. He was therefore able to seek employment independently. This transition of symptoms assumes an aspect of adolescent mentality and presents a trial and error approach to establishing a social identity. In general, somatization is assumed to be an immature defense mechanism of individual psychopathology. However, somatization may be a sign of an improvement in one's health. Somatization in adolescence may also be a sign of the beginning of a reintegration into society and have a bridging functional aspect that induces socialization in adulthood.     

Effects of colchicine and phenothiazine on biliary excretion of organic anions in rats

Vesicular transport inhibitors have been reported to inhibit biliary excretion of some organic anions, suggesting that vesicular transport has a role in intracellular transport of these compounds. However, these inhibitors are substrates for P-glycoprotein. To examine whether P-glycoprotein has a role in canalicular transport of organic anions in addition to the canalicular multispecific organic anion transporter, we studied the effect of colchicine, a vesicular transport inhibitor, and phenothiazine to increase P-glycoprotein expression on biliary excretion of various organic anions in rats. Colchicine treatment slightly but significantly inhibited biliary excretion of indocyanine green, dinitrophenylglutathione and pravastatin, and had no effect on biliary excretion of sulphobromophthalein and dibromosulphophthalein. Phenothiazine treatment did not affect biliary excretion of indocyanine green and pravastatin, but it increased biliary sulphobromophthalein-glutathione excretion. In conclusion, the present findings suggest that P-glycoprotein plays an additive role on biliary excretion of some organic anions in addition to the canalicular multispecific organic anion transporter.     

Fas-associated phosphatase-1 promotes Fas-mediated apoptosis in human colon cancer cells: Novel function of FAP-1

Background and Aim: Fas‐associated phosphatase‐1 (FAP‐1) has been thought as an inhibitor in Fas‐mediated apoptosis. Here, we investigated the role of FAP‐1 in Fas‐mediated apoptosis of human colon cancer cells. Method: The viability of four colon cancer cell lines treated with agonistic anti‐Fas antibody was determined using WST‐1 assay and cell death detection ELISA. pRc/CMV‐FAP‐1 was transfected to a FAP‐1‐negative, Fas‐resistant colon cancer cell line SW480 by lipofection and the clones expressing FAP‐1 protein were selected by limiting dilution. In the clones, expression of 550 genes was analyzed by cDNA microarrays. Protein expression of FAP‐1 and molecules related to apoptosis was examined by western blot. Results: We obtained two FAP‐1 overexpressed clones which were much more susceptible to Fas‐mediated apoptosis than control cells. In the clones, caspase 8 and caspase 3 were fully activated by agonistic anti‐Fas antibody treatment. Bcl‐2 family proteins were not related to the high susceptibility of these clones, because caspase 9 was not activated. Transfection of FAP‐1 did not suppress the survival actions of insulin‐like growth factor (IGF‐1) which enhanced survival signal through Akt phosphorylation. Upregulation in 21 genes and downregulation in 29 genes was revealed by cDNA arrays. We confirmed protein expression of p21 and phosphorylated p21 were much more enhanced in the clones than in control cells. Conclusions: Overexpression of FAP‐1 enhanced susceptibility to Fas‐mediated apoptosis in SW480 and upregulation of p21 may contribute to this phenomenon. Our results indicate a novel function of FAP‐1 in Fas‐mediated apoptosis of human colon cancer cells.