Search

Background: The best response to surgical treatment of primary aldosteronism occurs in patients with an aldosterone-producing adenoma (APA), so pre-operative localization of the lesion is necessary., Methods: A comparison was made of five localizing modalities-computed tomography (CT) of the adrenal gland, magnetic resonance imaging (MRI), dexamethasone suppression-131I-19-cholesterol adrenal scintiscan (DS, NP-59 adrenal scan), adrenal venography (venography) and adrenal venous sampling for aldosterone content (AVS) in 22 patients (12 women, 10 men) with primary aldosteronism; all had undergone operative confirmation within the past 9 years. The age at diagnosis ranged from 27 to 67 years (mean: 39.7)., Results: Unilateral adrenalectomy resulted in normal blood pressure without medication in 63.6% (14/22), and in improvement in 36.4% (8/22). Correct localization of the lesion was obtained in 95% (20/21) by CT, 100% (7/7) by MRI, 80% (12/15) by DS,NP-59 adrenal scan, 100% (6/6) by AVS and 78% (7/9) by venography., Conclusions: This experience would advocate CT of the adrenals as the initial means of localizing an APA on an outpatient basis because it is comfortable, safe, inexpensive and gives immediate results. The major role of MRI in the evaluation of adrenal adenoma should be complementary to CT. DS, NP-59 adrenal scan can be an adjuvant method for localization if CT scan results are not definitive. Adrenal venous catheterization with blood sampling for aldosterone content could be reserved for patients whose biochemical finging suggests the presence of an APA, and for whom CT or MRI of the adrenals and DS, NP-59 adrenal scan are inconclusive.

We have performed penile vein ligation on 35 patients with venogenic impotence from July 1989 to December 1991. The criteria for surgery were (1) age less than 60 years; (2) negative vasoactive agent intracavernous injection but normal penile arterial function, and (3) abnormal venous leakage documented by dynamic infusion cavernosometry and cavernosography. The procedure in venous ligation is excision of the deep dorsal vein from coronary sulcus to pubic arch, and ligation of cavernous veins after identification. The average follow-up was 27.5 months (range 12-37 months) for 30 patients. The 2 patients who revealed no erection at all immediately after operation had dense adhesion of penile hilar region caused in one case by severe pelvic trauma and in the other by pubic bone fracture. Twenty-eight (93.3%) patients were found to sustain excellent erection within 3 months postoperatively. However, only 12 (40.0%) patients sustained spontaneous erection at long-term follow-up, while another 7 (23.3%) responded to intracavernous injection. It is worth mentioning that tortuous and marked dilation of the deep dorsal vein and/or cavernous veins were found intraoperatively in 6 patients who were observed to have excellent erections postoperatively. Inadequate elimination of the leakage veins, especially crural veins, is the most likely factor in those who had a recurrence of erectile dysfunction. However, the corpus cavernosum, particularly a myopathic condition or inadequate neurotransmitters, also plays an important role. Complications included shortness of penis (3 patients), penile deviation (3), numbness of glans penis (4) and wound infection (1).(ABSTRACT TRUNCATED AT 250 WORDS)

A novel precursor neuropeptide termed 7B2 is present within specific brain areas, including the hypothalamic magnocellular neurosecretory neurons, and appears to be processed to smaller fragments. In order to determine whether specific C-terminal fragments of 7B2 might exert local effects on neurosecretory cells, we used intracellular current-clamp recordings in supraoptic neurons maintained in superfused hypothalamic explants to evaluate membrane potential and resistance changes in 25 supraoptic nucleus neurons during bolus applications of 7B2 174-186 and two other C-terminal peptide fragments 7B2 156-173 and 7B2 141-150. In 15 supraoptic neurons, only the 7B2 174-186 fragment induced a gradual 2-8 mV membrane depolarization that lasted for 4 to 30 min and was accompanied by 15+/-8% reduction in input resistance. Immunocytochemical identification of the recorded cells revealed that both vasopressin (VP)- and oxytocin (OT)-containing neurons were depolarized by 7B2 174-186. These data suggest that 7B2 174-186 is a biologically active fragment of 7B2 and may regulate the excitability of magnocellular supraoptic nucleus neurons.

Perycit (Pentaerythriol Tetranicotinate), a slow releasing drug, is one of the drugs used for treating hyperlipemia. Patients with erectile dysfunction (impotence) associated with hyperlipemia increasingly seek help at urological services. This study investigates the clinical effect, both objective and subjective of Perycit on anti-hyperlipemia as well as on impotence. Twenty patients with a more than one year history of impotence with hyperlipemia were enrolled in this randomized, single-blind study. Decrease of total cholesterol, and triglyceride, as well as the increase of high density lipoprotein cholesterol in the study group (Perycit, 500 mg, tid, for 3 months) were significantly different from the pre-treatment period and in the control group (Trental, 100 mg, tid, for 3 months) (p < 0.05 or p < 0.01). Moreover, improvement in sexual function was shown to be better in the study group than in either the pretreatment period and control groups, objectively and subjectively (p < 0.05 or p < 0.01). Tolerable facial flush was found in 3 of these 20 patients, but no major side effects were encountered. In conclusion, this study indicates Perycit is effective for anti-hyperlipemia as well as for aiding improvement of sexual dysfunction. Since it is a slow-releasing preparation, the side effect is minimal. It is recommended for patients with hyperlipemia alone, or those who suffer from combined erectile dysfunction.

A 65-year-old man presented with renal cell carcinoma of the right kidney with a tumor thrombus extending up the vena cava to the right atrium. Cardiopulmonary bypass, profound hypothermia and total circulatory arrest were used to create a bloodless field for excision of the renal cell carcinoma and its tumor thrombus. Acute respiratory failure and deep jaundice developed after the operation and the patient was transferred to the intensive care unit for critical care. After respiratory therapy and nutritional support, the liver function was restored. The endotracheal tube was weaned one month later. The patient has had total resolution of all symptoms and there is no evidence of tumor recurrence of distant metastases after 6 months follow-up.

The present study revealed the effect of prolactin (PRL) and sex steroid hormones on production of prostatic acid phosphatase (PAP) of the immature rat prostatic epithelial cells in serum-free medium. The results showed that PRL significantly stimulated synthesis and secretion of PAP, but failed to synergize with dihydrotestosterone or estradiol. Dihydrotestosterone or estradiol alone did not promote PAP production. Studies on the mechanism of PRL action indicated that adenyl cyclase was not activated in the action of PRL: Synergistic effect between PRL and prostaglandin E2 and F2 alpha was revealed in the stimulation of PAP production, and the effect of PRL could be blocked by indomethacin (a prostaglandin synthesis inhibitor). In conclusion, PRL directly stimulated PAP production of the cultured rat prostatic epithelial cells in serum-free medium and prostaglandin was involved in PRL action.

In a previous paper, we reported the isolation and structure determination of three new steroidal saponins, dongnosides C (3), D (2) and E (1) from the dried fermented residues of leaf-juices of Agave sisalana forma Dong No. 1. In a continuing study on this plant, two additional new major steroidal saponins, named dongnosides B (4) and A (5), were obtained. Their structures were characterized respectively as tigogenin 3-O-alpha-L-rhamonpyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)- [beta-D- glucopyranosyl-(1-->3)]-beta-D-glucopyranosyl-(1-->4)-beta-D-galactop yranoside and 3-O-alpha-L-rhamnopyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)-[beta- D- xylopyranosyl-(1-->3)-beta-D-glucopyranosyl-(1-->3)]-beta-D- glucopyranosyl-(1-->4)-beta-D-galactopyranoside on the basis of chemical and physicochemical evidence.

Since its introduction, extracorporeal shock-wave lithotripsy (ESWL) has become the treatment of choice in patients with urinary calculi. But the pain during ESWL is intolerable for many patients. Tramadol HCL resembles morphine in that it depresses motor and sensory responses of the spinal nociceptive system by a spinal and a supraspinal action. The side effects of tramadol are less than morphine. A prospective study was performed to determine the effect of tramadol in ESWL for the patients with urinary tract calculi. Ninety patients were randomized divided into three groups. Group A 40 patients (male:female = 31:9) received oral tramadol HC1 100 mg; group B 17 patients (male:female = 12.5) received multi-vita; group C 33 patients (male:female = 26:7) received analgesic (contained aspirin 399 mg and codeine phosphate 15 mg). The patients took the drugs 30 minutes before ESWL. The patients with renal calculi > 2 cm in diameter or ureteral calculi > 1 cm in diameter were excluded. The lithotriper used in our hospital is Siemens Lithostar. According to the description of the patients postoperatively, the pain intensity during ESWL was identified with Verbal Scale and Visual Analogue Scale (VAS). The statistical method is one-way ANOVA. Statistical difference is significant when p < 0.05. The mean age of patients group A is 46.5 +/- 17.1, group B 45.5 +/- 14.4, and group C 50.5 +/- 14.6. The mean diameter of urinary calculi of group A is 0.98 +/- 0.41 cm, group B 1.09 +/- 0.33, and group C 1.06 +/- 0.43.(ABSTRACT TRUNCATED AT 250 WORDS)

Four patients with left-sided accessory pathways (APs) and unusual coronary sinus (CS) received radiofrequency ablation. Unusual CS included occlusion of CS (patient 1), acute angulation of proximal CS (patients 2 and 3), and narrowing of CS orifice and proximal segment (patient 4). CS catheterization and AP mapping along the CS could not be performed in the four patients. Radiofrequency ablation by left ventricular retrograde technique for the manifest left posteroseptal AP (patient 1), concealed left posterior AP (patient 2), and transseptal left atrial technique for the manifest left posteroseptal AP (patient 3) and manifest left posterior AP (patient 4) were performed successfully without CS catheter guidance. This study suggests that radiofrequency ablation of left-sided AP with unusual CS is feasible by some special techniques.

Four new steroid saponins, kingianosides A-D, were isolated from the rhizome of Polygonatum kingianum, together with two known steroid saponins. On the basis of chemical and spectral evidence, the structures of kingianosides A-D were established as gentrogenin 3-O-beta-D-glucopyranosyl (1-->4)-beta-D-galactopyranoside, gentrogenin 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-fucopyranoside, 26-O-beta-D-glucopyranosyl-22-hydroxy-25(R)-furost-5-en-12-on-3 beta, 22-diol 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-galactopyranoside and 26-O-beta-D-glucopyranosyl-22-hydroxy-25(R)-furost-5-en-12-on-3 beta,22-diol 3-O-beta-D-glucopyranosyl(1-->4)-beta-D-fucopyranoside, respectively.

Two new triterpenoidal saponins, butyrosides A and B, were isolated from the seeds of Madhuca butyracea, along with two known saponins, Mi-saponin A and 16 alpha-hydroxy Mi-saponin A. On the basis of chemical and spectroscopic evidence, the structures of butyrosides A and B were established to be 3-O-beta-D-glucopyranosyl protobassic acid 28-O-beta-D-apiofuranosyl(1----3)-beta-D-xylopyranosyl (----4)-alpha-L-rhamnopyranosyl(1----2)-alpha-L-arabinopyranoside and 3-O-beta-D-glucopyranosyl 16 alpha-hydroxy protobassic acid 28-O-beta-D-apiofuranosyl(1----3)-beta-D-xylopyranosyl (1----4)-alpha-L-rhamnopyranosyl(1----2)-alpha-L-arabinopyranoside , respectively.

Transrectal fine needle aspiration and biopsy were performed on 100 patients with suspicious prostatic lesions using 22 gauge aspiration needles and 18 gauge biopsy needles. These collections were made from January 1990 to June 1991. Sufficient prostate tissue for cytological and histological diagnosis were obtained in 97% (97/100) and 99% (99/100), respectively. Thirty-nine patients (39%) were diagnosed having cancer with an accuracy rate of 89.7% (35/39) by histology and 69.2% (27/39) by cytology. One patient with a normal cytological aspiration was found to have an atypical biopsy, therefore, the biopsy was repeated and the prostate showed adenocarcinoma. Our results indicate that the needle aspiration cytology has a less accurate diagnosis rate than the needle biopsy histology. Fine needle aspiration is a safe and effective outpatient procedure but there is a definite learning curve before its use can be fully exploited. It is important to have experienced urologists and pathologists to perform these aspirations until sufficient experience is accumulated.

From the roots of Glycyrrhiza yunnanensis, collected in Yunnan, China, six new oleanane-type triterpene glycosides named yunganosides A1, B1, C1, D1, E2 and F2 were isolated together with hypaphorine. The structures of these glycosides were established by spectroscopic and chemical means.

Four new oleanane triterpenoid saponins named triplosides D-G were isolated from the roots of Triplostegia grandiflora. Their structures were elucidated on the basis of chemical degradation and spectral evidence. The saponins investigated were: oleanolic acid 3-O-beta-D-xylopyranosyl(1----4)-beta-D-xylopyranosyl(1----3)-beta-D- xylopyranosyl(1----4)-alpha-L-rhamnopyranosyl(1----3)-beta-D- xylopyranosyl(1----3)-alpha-L-rhamnopyranosyl(1----2)-beta-D-xylopyranos ide, oleanolic acid 3-O-beta-D-glucopyranosyl(1----6)-[beta-D- xylopyranosyl(1----4)]-beta-D-glucopyranosyl(1----3)-beta-D- xylopyranosyl(1----4)-alpha-L-rhamnopyranosyl(1----3)-beta-D- xylopyranosyl(1----3)-alpha-L-rhamnopyranosyl(1----2)-beta-D-xylopyranos ide, oleanolic acid 3-O-beta-D-xylopyranosyl(1----3)-beta-D-xylopyranosyl(1----4)- alpha-L-rhamnopyranosyl(1----3)-beta-D-xylopyranosyl(1----3)-alpha-L- rhamnopyranosyl(1----2)-beta-D-xylopyranoside and oleanolic acid 3-O-alpha-L-rhamnopyranosyl(1----3)-beta-D-xylopyranosyl(1---3)-alpha-L- rhamnopyranosyl(1----2)-beta-D-xylopyranoside, respectively. All of them have a common aglycone and are monodesmosides.

A study group of 240 impotent men receiving intracorporeal injections were divided into 2 groups: the first group received papaverine (60 mg) and the second prostaglandin E1 (PGE1 20 micrograms). The effect of the drugs was evaluated according to the onset of erection, rigidity and the duration of erection; 136 patients were treated with papaverine and 104 with PGE1. The onset of action in these groups was 6.42 +/- 5.39 vs 10.14 +/- 5.41 min; the rigidity score was 3.37 +/- 0.89 vs 3.60 +/- 1.10 and the duration of erection was 49.56 +/- 62.56 vs 63.60 +/- 44.57 min respectively. There was a significant difference in the onset of action (PGE1 was slower than papaverine) and maintenance of erection (longer with PGE1 than with papaverine). Another group of 17 patients received both papaverine and PGE1. The effects of papaverine were better in 4 cases, worse in 5 and equal to PGE1 in 8. This study indicates that compared with papaverine, treatment with PGE1 produces a slower onset of action, a longer duration of erection and fewer side effects.

Citrate is recognized as one of the inhibitors of urinary stone formation. If the urinary citrate and pH could be elevated by the supply of potassium citrate, the recurrence of stone formation would hopefully be prevented. Urocit-K is a kind of slow releasing preparation of potassium citrate. The pharmacokinetics of Urocit-K is investigated in this study, which included two groups: 1) the hypocitraturia group consisting of twenty patients and 2) the normal volunteer group consisting of ten persons. Urokit-K was administered to patients in 10 mEq doses, t.i.d. for 2 weeks. Comparison of urinary biochemistry was done prior to, and one week after administration of the Urocit-K. In the normal volunteer group, the pharmacokinetics of Urocit-K was determined by urinary pH, K, and citrate. Determinations were made six times a day (every 2-hours for first 8 hours, 7- and 9- hours for the last 16 hours) with Urocit-K for comparison. This study indicated that Urocit-K increases urinary pH, K, and citrate in hypocitraturic patients. In the normal volunteer group, Urocit-K deserves its slow-releasing property shown by a constant increase of urinary pH and K for the first 8 hours; and urinary citrate for almost 24 hours. No apparent complications, such as gastrointestinal upset or cardiopulmonary discomfort were observed. In conclusion, Urocit-K is an excellent preparation of potassium citrate and a good choice for prevention of stone recurrence.

Ureteral obstruction leading to pain seems to be related to an increase of renal prostaglandins (PG). We designed a prospective double-blind, placebo controlled protocol for evaluating the effect of indomethacin, a PG-synthetase inhibitor, in the prophylaxis of ureteral colic following extracorporeal shock wave lithotripsy (ESWL). Sixty patients undergoing ESWL were randomized into two groups, group 1 (study group) received 50 mg indomethacin capsule three times daily and group 2 (control group) received multiple-vitamin tablet three times daily. Twenty-four hours urine samples were collected before and three days after ESWL was performed for PGE2 (predominant renal PG) determination. Subjective pain after ESWL was recorded with pain score (0-10 degrees). Oral codein or pethidine injection were available for relieving pain following ESWL. The pain score, analgesic requirement and urinary PGE2 in pre- and post-ESWL were used to compare the two groups. The pain score was 4.00 +/- 0.25 and 3.00 +/- 0.25 in the control and study groups respectively; it had a statistically significant difference (p < 0.01). In control group, 12 and 14 patients required 23 doses of codein and 18 doses of pethidine. In the study group, three and four patients required five doses of codein and eight doses of pethidine. The difference was statistically significant (p < 0.05). In the control group, the mean pre- and post-ESWL urinary PGE2 was 305 +/- 65.8 and 474 +/- 101 micrograms/24-hr respectively. In the study group, the mean pre- and post-ESWL urinary PGE2 was 289 +/- 60.7 and 186 +/- 26.5 micrograms/24-hr respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A total of 64 renal graft biopsies performed on 44 transplant patients from among 116 transplants (12 from living donors, 104 from cadavers) were analyzed during the period from July 1983 to December 1990. The frequency of allograft glomerular disease was 22.7% (10/44). Membranous glomerulonephritis (MGN) was detected in five patients; focal segmental glomerulosclerosis (FSGS), in two; transplant glomerulopathy, in two; and IgA nephropathy, in one. Nephrotic syndrome occurred in nine of the ten patients. Progressive deterioration of graft function developed in four patients associated with chronic rejection, and two of them later lost the graft. The remaining six patients had no chronic rejection and retained a stable renal condition with one exception, a patient who suffered from acute total occlusion of the right internal iliac artery and who eventually lost the graft. It is concluded that MGN is the most common allograft glomerular disease, but the outcome of the graft is probably related to the coexistent chronic rejection.

1. Intracellular current and voltage clamp recordings were obtained from rat supraoptic nucleus neurones in superfused hypothalamic explants in order to evaluate their response to dopamine and to D1 and D2 agonists. 2. With one exception, exposure to dopamine (10-200 microM) depolarized supraoptic neurones. When tested for an effect on twenty-one spontaneously active supraoptic neurones, dopamine enhanced the firing of all eleven continuous-firing (possibly oxytocin-secreting) neurones and prolonged the burst in all ten phasic-firing (vasopressin-secreting) neurones. 3. In sixty-seven of sixty-eight neurones where current injection was used to maintain membrane potential below threshold for action potential generation, current clamp data revealed that exposure to dopamine (10-200 microM) was followed in 10-17 s by a gradual 3-7 mV membrane depolarization that lasted for 4-15 min and was accompanied by a 12-23% reduction in input resistance. Exposure to quinpirole, a D2 agonist (10-200 microM), induced a similar response with comparable onset, duration and change in input resistance. In contrast, tests on sixteen cells indicated little or no response to a D1 agonist SKF38393. 4. Under voltage clamp, dopamine was noted to induce an inward current, accompanied by a 7.5-40% increase in membrane conductance over the corresponding time course. 5. Voltage-current plots for dopamine-induced depolarizations were linear in the range -50 to -110 mV. Dopamine and quinpirole depolarizations had extrapolated mean reversal potentials of -25 +/- 10 mV (mean +/- S.D.) and -20 +/- 15 mV respectively. This approximated the mean reversal potential of -20 +/- 8 mV measured from the dopamine-induced inward current using single-electrode voltage clamp. 6. The actions of dopamine were selectively antagonized by two D2 receptor antagonists, sulpiride and spiperone, but neither influenced membrane depolarizations induced by equimolar concentrations of noradrenaline. Dopamine-induced depolarizations also persisted following selective blockade of alpha 1-adrenergic receptors by prazosin; under these conditions, noradrenaline induced membrane hyperpolarization. 7. Following complete substitution of external Na+ with Tris, the reversal potential for the dopamine-induced response was shifted to -70 +/- 9.8 mV. This value was consistently less negative than the estimated potassium equilibrium potential. 8. The depolarization action of dopamine persisted in media containing tetrodotoxin and with an external calcium concentration ([Ca2+]o) of 0 mM-Ca2+ with 6 mM-Mg2+ or Mn2+, but was abolished following intracellular injection of [1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid (BAPTA), a Ca2+ chelator.(ABSTRACT TRUNCATED AT 400 WORDS)

We reported 29 kidneys with angiomyolipoma in 23 patients (14 women and 9 men). One of these cases was associated with tuberous sclerosis. Their age ranged from 20 to 82 years (mean 48.9). Six patients had bilateral renal involvement and 7 had multiple lesions in one kidney. Synchronous renal tumors were noted in three patients. One patient was associated with renal cell carcinoma, and the other two patients with transitional cell carcinoma. Nineteen tumors in 16 patients were larger than 4 cm. Among them 93.8% (15/16 patients) were symptomatic and tumor hemorrhage was found in 57.9% (11/19 kidneys). Of these patients, 17 renal units underwent surgical intervention (including 8 total nephrectomy, 7 partial nephrectomy and 2 enucleation of tumor). Preoperative diagnosis was made in 82.4% (14/17) with combined imaging of sonogram and CT scan. One patient received embolization only. There were two mortalities: one patient with tumor rupture who received emergent nephrectomy but died of irreversible hypovolemic shock, and the other with tuberous sclerosis and pulmonary fibrosis who received embolization for spontaneous rupture of tumor but expired due to respiratory failure. Among nine patients receiving renal preserving operation, the post-operative effective renal plasma flow of the affected kidneys ranged from 96 to 184 ml/min (mean 131.7 ml/min). There was no evidence of recurrence during a mean followup of 2.6 years. Eight asymptomatic patients with 9 renal masses had incidental angiomyolipoma and did not undergo exploration. We did not note any progression of the lesions in the cases under observation for a mean followup of 2.6 years.(ABSTRACT TRUNCATED AT 250 WORDS)

From November 1982 to August 1990, 16 patients with primary retroperitoneal sarcoma were treated in our hospital. The most frequent types of tumor were liposarcoma (6), malignant fibrous histiocytoma (3). The commonest clinical findings were palpable abdominal mass (14/16). In management of these patients; nine patients underwent complete resection of the tumor; three patients underwent partial resection of the tumor and four patients underwent biopsy only. The histology of tumor appeared to have prognostic significance. Patients suffering from liposarcoma (3/5) and malignant fibrous histiocytoma (1/2) survived the longest. With a mean follow up of 25.0 months, the three year overall survival rate of complete resection group was 50 per cent. No patients with partial resection and biopsy only group survive three years and the total three-years overall survival rate was 29%. The mean survival for patients after adjuvant chemotherapy and/or radiotherapy was similar to that after a radical operation alone. The prognosis of primary retroperitoneal sarcoma is grave and complete resection of the tumor as initial treatment seems to provide the only chance of cure for these patients.

Renal oncocytoma was previously reported as a benign tumor arising from proximal tubular epithelial cells, but malignant potential with local invasion and distant metastasis has been emphasized in recent literature. It is difficult to differentiate it from renal cell carcinoma, but four typical angiographical signs may give suggestive evidence of the tumor. Radical nephrectomy with lymphadenectomy may be the choice of treatment, except in solitary kidney, bilateral tumors, or contralateral renal cell carcinoma. We report two female patients who were found incidentally to have renal tumors during a survey of right upper quadrant pain. Typical angiographic signs were found incidentally to have renal tumors during a survey of right upper quadrant pain. Typical angiographic signs were found in one patient, and atypical signs in the other. Three and eight years after radical nephrectomy with para-aortic lymphadenectomy, there has been no evidence of local recurrence or distant metastasis.

The dorsal and deep arteries are the 2 main blood supplies to the penis. High resolution ultrasonography was used to evaluate the role of these 2 sets of arteries in erection. A total of 44 impotent patients entered this study. We used duplex ultrasonography (Diasonic DRF/400) to assess the role of the dorsal and deep arteries in arteriogenic and nonarteriogenic impotent patients. Vascular velocity, as well as the change in diameter, was recorded before and after an intracavernous injection of 60 mg. papaverine. In the arteriogenic impotence group (28 patients, 63.6%), the velocity increments were 37.1 +/- 23.6 (right side) and 35.4 +/- 17.5 (left side) cm. per second in the dorsal arteries, and 8.3 +/- 5.9 (right side) and 12.6 +/- 5.6 (left side) cm. per second in the deep arteries. In the nonarteriogenic group (16 patients, 36.4%) the velocity increments were 46.5 +/- 25.2 and 41.1 +/- 22.4, respectively, in the dorsal arteries, and 37.3 +/- 16.5 and 37.5 +/- 15.8, respectively, in the deep arteries. Comparison of the velocity increments between the arteriogenic and nonarteriogenic groups revealed no difference in the dorsal arteries (p greater than 0.1) but a significant difference was noted in the deep arteries (p less than 0.01). Similar findings were also encountered when the velocities and diameter increments were compared. This study indicates that the deep arteries have an important role in erectile response, while the dorsal arteries are less important.

Of a total 260 impotent patients entered in a hormonal study, serum testosterone, prolactin and hormonal abnormalities were detected in 30 (11.5%) patients (18 with hypotestosteronemia and 12 with hyperprolactinemia). The 18 cases of hypotestosteronemia included: 8 cases of hypergonadotropic hypogonadism due to klinefelter's syndrome (1), orchitis (2), chronic alcoholism (1), and idiopathic primary gonadal failure (4) and 10 cases etiologically unknown hypotestosteronemia. Nine of the 18 patients also displayed other organic etiologies (6 vasculogenic and 3 diabetic impotence). After replacement of testosterone propionate by intramuscular injection, the improvement in impotence was significant in 12 patients (excellent in 1, good in 11) and insignificant in 6 (poor in 3, no response in 3). The positive response rate was 89% (8/9) for sole hypotestosteronemia and 44% (4/9) for hypotestosteronemia accompanied by other organic causes of impotence. In the 12 patients with hyperprolactinemia, 4 had prolactinomas. Of these, 3 were treated by surgery and 1 with bromocriptine. Three (excellent in 2, good in 1) of the 4 showed a positive erection response afterwards, but the other patient's response was poor because of postoperative residual tumor. Two patients had drug-induced hyperprolactinemia (haloperidol and methyldopa) and for one, impotence was improved after withdrawal of haloperidol. However, the other responded poorly due to vasculogenic impotence. Six patients with hyperprolactinemia of unknown etiology (2 accompanied by vasculogenic impotence, 2 by diabetic impotence and 2 by sole hyperprolactinemia) were treated with bromocriptine and improvement was noted in 3. The positive response rate was 71.4% (5/7) for sole hyperprolactinemia and 40% (2/5) for hyperprolactinemia accompanied by other organic causes of impotence. Good results were achieved in prolactinoma, sole hyperprolactinemia and hypotestosteronemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantification of acetabular coverage is important and can be expressed by superimposition of cartilage tracings on the maximum cross-sectional area of the femoral head. A practical Autolisp program on PC AutoCAD has been developed by us to quantify the acetabular coverage through numerical expression of the images of computed tomography. Thirty adults (60 hips) with normal center-edge angle and acetabular index in plain X ray were randomly selected for serial drops. These slices were prepared with a fixed coordination and in continuous sections of 5 mm in thickness. The contours of the cartilage of each section were digitized into a PC computer and processed by AutoCAD programs to quantify and characterize the acetabular coverage of normal and dysplastic adult hips. We found that a total coverage ratio of greater than 80%, an anterior coverage ratio of greater than 75% and a posterior coverage ratio of greater than 80% can be categorized in a normal group. Polar edge distance is a good indicator for the evaluation of preoperative and postoperative coverage conditions. For standardization and evaluation of acetabular coverage, the most suitable parameters are the total coverage ratio, anterior coverage ratio, posterior coverage ratio and polar edge distance. However, medial coverage and lateral coverage ratios are indispensable in cases of dysplastic hip because variations between them are so great that acetabuloplasty may be impossible. This program can also be used to classify precisely the type of dysplastic hip.

Repeated intracavernous injections in healthy monkeys with 2 kinds of vasoactive agents [papaverine and prostaglandin E1 (PGE1) 3 monkeys each] and normal saline (2 monkeys) were conducted in this study. The purpose was to observe the effect of long-term injection on histopathological changes of the cavernous tissue, as well as the change in drug sensitivity (dosage dependence). Different dosages of the same volume (double, single and half dose) of these 3 agents were injected, twice weekly, 10 times alternatively, with rigidity and maintenance of erection recorded. After long-term injection (papaverine group: 37, 60, 60 times; PGE1 group: 26, 60, 60 times; normal saline group: 60, 60 times), all monkeys were sacrificed and the penises were collected for light-microscopic (LM) and electron-microscopic (EM) examinations. Dose-dependent response with reversed drug sensitivity was found in the papaverine group, but only elongation to tumescence was found in the PGE1 group, even with double dosage (probably because of scarce PGE1 receptors in monkey's penile tissue). Histopathologically, mild to moderate fibrotic changes and distortion of normal architecture were predominant findings in LM while aggregation of mitochondria, irregular shape or atrophy of cells were obvious in EM observation in the papaverine group. On the other hand, limited fibrosis with preservation of corpora cavernosa and hypertrophy of smooth muscle were noted in the PGE1 group. This study indicated that less histopathological change occurred in the PGE1 group after long-term intracavernous injection.

A new phenylpropanoid glycoside, brandioside, was isolated from Brandisia hancei. Its structure, [beta-(3',4'-dihydroxylphenyl)-ethyl]-(2-O-acetyl)-(3,6-O-di-alpha -L-rhamnopyranosyl)-(4-O-caffeoyl)-beta-D-glucopyranoside, was established by chemical and spectroscopic methods.

Five main saponins were separated from the cell cultures of Panax notoginseng (Burk) F. H. Chen. They were sanchinoside Rb1, Re, R1, Rg1 and Rh1 identified by TLC, HPLC, IR, M. P., 13CNMR and EI-MS. Saponin components of the cell cultures were almost the same as those of the cultivated plants. But the content of saponins was different between the cell cultures and the cultivated plants. Saponin extraction and separation procedure suitable for the cell cultures has to be different from that for the cultivated plants.

Methanolic extracts of the stalks of Mucuna birdwoodiana on acid hydrolysis and subsequent methylation with diazomethane provided four triterpene sapogenols. On the other hand, investigation of glycosides after methylation of the same extract led to the isolation of four triterpene glycosides. On the basis of chemical and spectral evidence, their structures were characterized as methyl asiatate, methyl maslinate, two new sapogenols, methyl 1 beta,2 alpha,3 beta,23-tetrahydroxyolean-12-en 28-oate (mucunagenin a), its urs-12-en isomer (mucunagenin b), 3-O-(6-O-methyl-beta-D-glucuronopyranosyl) methyl asiatate 3-O-[alpha-L-arabinopyranosyl(1----2)]-6-O-methyl-beta-D-glucur onopyranosyl methyl maslinate, 3-O-[alpha-L-arabinopyranosyl(1----2)]-6-O-methyl-beta-D-glucur onopyranosyl methyl asiatate and 3-O-(6-O-methyl-beta-D-glucuronopyranosyl) asiatic acid 28-O-beta-D-glucopyranoside.

The contribution of hippocampal glutamatergic and VTA dopaminergic inputs to the nucleus accumbens and the role of accumbens--ventral and subpallidal GABAergic pathway in integrating the limbic signals into motor responses via pedunculopontine nucleus were examined with electrophysiological and behavioural techniques. Stimulation of hippocampal input to the accumbens activates GABAergic output to the subpallidal area which leads to suppression of spontaneous firing of subpallidal neurons, while activation of dopamine receptors in the accumbens suppresses GABAergic output to subpallidal area and thus increases the firing of picrotoxin-sensitive ventral pallidal neurons. However, both treatments induced hypermotility suggesting the functional heterogeneity of the ventral and subpallidal areas in "limbic-motor integration". Furthermore, both hippocampal output signals and dopaminergic input to the accumbens descend via ventral and subpallidal areas serially to the pedunculopontine nucleus, the region of the mesencephalic locomotor region. In addition, a parallel ascending pathway from the subpallidal area to the mediodorsal nucleus, and subsequently to the medial prefrontal cortex, probably mediates behaviour, e.g. food hoarding, that requires higher cognitive processing.

A surveillance of diarrhoeal diseases in children aged under five years was carried out from March 1986 to February 1987 in a rural area of Hebei Province, China. Using a cluster sampling method, 270 study children were selected from 30 villages to represent a population of 105,405. Parents noted episodes of diarrhoea in children on a calender using a given definition of diarrhoea. The findings were verified by trained village doctors and were recorded monthly in the county Health and Anti-epidemic Stations. Stools of diarrhoea-affected children were examined to detect causal agents of diarrhoea, once in each of four seasons of the year. Of the 270 children, 218 (80.74%) suffered from one or more than one attacks of diarrhoea with a 95% confidence interval between 75.94% and 85.54%. There was no death due to diarrhoea. The diarrhoeal incidence in children of 3-4-year age group was significantly less than that in the children of less than 3 years (p less than 0.05). In the children with diarrhoea, the number of mean episodes was 3.15 per child/year, and the total mean course of suffering was 14 days per child/year. The ratio of diarrhoeal episodes in spring, summer, autumn, and winter was about 2.5:5:2:1. July was the month of highest occurrence of diarrhoea (146; 21.28% of all episodes). The epidemiological parameters of the disease declined with the growing age of the children, and there was no gender-specific preponderance in the number of episodes. During the whole year, 21.7% of the diarrhoeal episodes were due to bacterial pathogens, 4% of the episodes were due to rotavirus, and 3.65% episodes were associated with the detection of Trichomonas hominis.(ABSTRACT TRUNCATED AT 250 WORDS)

Two control volunteers and 8 impotent patients entered this study for evaluation of arterial function and venous competence of the corpus cavernosum. The skin and corporeal xenon-133 (Xe-133) penile washout tests were conducted on each person before and 5 and 60 minutes after an intracavernous injection of prostaglandin E1. The half-time clearance (T 1/2) and blood flow (Q) were used for evaluation. The parameters of the skin washout test obtained from impotent patients changed from T 1/2 = 14.3 +/- 6.2 minutes, Q = 3.75 +/- 2.56 ml/100g tissue/minute preinjection to T 1/2 = 5.23 +/- 1.78, Q = 9.96 +/- 2.69 at 5 minutes post-injection and T 1/2 = 3.89 +/- 0.86, Q = 12.9 +/- 3.0 at 60 minutes post-injection, p less than 0.01; while the corporeal washout test changed from T 1/2 = 84.6 +/- 107.1 minutes, Q = 2.91 +/- 3.17 ml/100g tissue/minute to T 1/2 = 41.2 +/- 99.6, Q = 10.6 +/- 9.7 and T 1/2 = 13.9 +/- 16.2, Q = 7.78 +/- 6.35, p less than 0.05, respectively. The flow ratio (post-injection/pre-injection) was 1.01-6.04 at 5 minutes and 1.39-8.01 at 60 minutes later in the skin washout test, and 1.07-72.2 at 5 minutes and 0.60-45.7 at 60 minutes in the corporeal washout test. However, the individual variations were considerable. This study suggests that the Xe-133 penile washout test after an intracavernous injection may help in demonstrating the hemodynamics of the cavernosal arteries and dorsal arteries, and in evaluating the severity of penile vascular impairment. Moreover, the flow ratio may reflect vascular compliance; the higher the ratio, the better the compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

The neuromodulatory action of dopamine (DA) on acetylcholine (ACh)-evoked responses of prefrontal cortex (PFC) neurones were investigated electrophysiologically in rats anaesthetised with a combination of urethane and ketamine. Iontophoretic application of ACh-excited prefrontal cortex neurones. Concurrent application of DA (5-15 nA) resulted in complex changes in the ACh-evoked responses: (1) DA depressed spontaneous background discharges (designated as noise) proportionally more than the ACh-evoked discharges (designated as input signals), thus yielding an enhanced signal/noise ratio. This increase in signal/noise ratio by dopamine was reversed by iontophoretic application of the Da D2 antagonist sulpiride (20-50 nA). Nevertheless, iontophoretic application of D2 agonist quinpirole (5-35 nA) enhanced the ACh-evoked response, but was accompanied by some increase in spontaneous discharge, thus yielding no change in the signal/noise ratio. (2) DA also increased the signal/noise ratio by inducing a net increase of the ACh-evoked response but simultaneously suppressed the spontaneous activity of PFC neurones. This effect was more prominent following blockade of D1 receptors by SCH23390 (6 mg/kg, i.p.), suggesting that D1 receptors may normally inhibit D2 receptor function in the PFC. In addition, endogenous DA in the PFC did not play a significant part in modifying the ACh-evoked responses since the modulation of ACh-evoked response by DA or its D1 and D2 agonists was similar in both saline control and alpha-methyl-p-tyrosine-pretreated rats. (3) When ejected with larger iontophoretic current (16-35 nA), DA suppressed both the ACh-evoked and spontaneous discharge and this effect was mimicked by D1 agonist SKF38393 (5-15 nA). Taken together, these results suggest that complex dopaminergic modulation of the cholinergic responses of prefrontal cortex neurones are mediated by D1 and D2 receptors. This DA action may have a functional role in the cognitive-integrative processes occurring in the prefrontal cortex.

After detailed instruction, 62 patients with urolithiasis treated at Taichung Veterans General Hospital entered this program, which ran from September 1987 to November 1988. Based on Pak's classification, there were 13 cases (21.0%) of absorptive hypercalciuria, type I (AH-I); 12 cases (19.4%) of absorptive hypercalciuria, type II (AH-II); 16 cases (25.8%) of renal hypercalciuria (RH); 3 cases (4.8%) of hyperuricosuric calcium urolithiasis (HUCU); 11 cases (17.7%) of hypocitraturia (Hypocit); 3 cases (4.8%) of hyperoxluria (HO); one case (1.6%) of primary hyperparathyroidism (PHPT) and one case (1.6%) of infectious lithiasis. Two cases (3.2%) with no metabolic abnormalities were found. Hypocitraturia, HUCU, and HO can be the primary abnormal findings, but more often coexist with various forms of hypercalciuria as a second factor. If the coexistence is considered, hypocitraturia (33 cases, 53.2%) and HUCU (24 cases, 38.7%) were the most prevalent categories. Meanwhile, 24 cases (38.7%) had only one physiological derangement, 25 cases (40.3%) had two derangements, and 13 cases (21.0%) had three. This study indicates that metabolic evaluation can elucidate the physiological derangements of urolithiasis, so that further medical treatment can be administered selectively.

Three new steroidal saponins, aspafilioside A, B and C together with a known saponin 22-methoxy ASP-IV and beta-ecdysone were isolated from the root of Asparagus filicinus Buch.-Ham. (Chinese name as xiao-bai-bu), a folk medicine of the minorities in Yunnan Province, China, used for the treatment of bronchitis, pneumonitis and cough. Their structures were established as sarsasa pogenin-3-O-beta-D-xy lopyranosyl (1----4)-beta-D-glucopyranoside (I), sarsasapogenin-3-O-beta-D-xylopyranosyl (1----4) [alpha-L-arabinopyranosyl (1----6)]-beta-D-glucopyranoside (II) and (25S)-5 beta-furost-3 beta, 22, 26-triol-3-O-beta-D-xylopyranosyl (1----4) [alpha-L-arabinopyranosyl(1----6)]-beta-D-glucopyranoside-26-O-bet a-D- glucopyranoside (III) by spectral and chemical methods.

The role of the glutamatergic hippocampal-nucleus accumbens pathway in relaying hippocampal information via the nucleus accumbens to the motor system was investigated behaviorally using the radial-arm maze paradigm in rats. Bilateral injections of kynurenic acid, a glutamate antagonist, into the nucleus accumbens increased the latency to initiate movement during performance of an 8-arm radial maze with all arms baited and with 4 arms baited. Injections of kynurenic acid did not change the number of visits to previously visited arms (i.e. working memory errors) on both versions of the 8-arm radial maze. However, on the 8-arm radial maze with 4 arms baited, injections increased the number of visits to unbaited arms (i.e. reference memory errors). Similar injections were made in rats with ibotenic acid lesions of the prefrontal cortex in order to eliminate the glutamatergic prefrontal cortex-nucleus accumbens pathway so as to investigate the glutamatergic hippocampal-nucleus accumbens pathway. These rats displayed similar deficits on the radial-arm maze as non-lesioned rats (i.e. enhanced latency to initiate movement and reference memory errors). These findings suggest that the glutamatergic hippocampal-accumbens pathway plays a role in radial-arm maze performance by transferring information required for performing a radial-arm maze to the motor system.

Extracellular single unit recordings were obtained from neurones in the nucleus accumbens of urethane anaesthetized rats. Single pulse stimulation (300-800 microA, 0.15 ms, 0.5-1.5 Hz) of the ventral subiculum of the hippocampus strongly excited silent and spontaneously active (3-6 spikes/s) medial accumbens neurones. The majority of neurones excited by hippocampal stimulation were quiescent and identified only by the elicited action potentials. Neurones on the dorso-medial border of the nucleus accumbens and adjacent lateral septum, with a faster spontaneous discharge rate (8-12 spikes/s), were inhibited by hippocampal stimulation. In the ventral border of the accumbens and the olfactory tubercle, hippocampal stimulation also inhibited the fast-firing (greater than 20 spikes/s) neurones. When trains of 10 conditioning pulses (300-800 microA, 0.15 ms, 10 Hz) were delivered to the ventral tegmental area (VTA) 100 ms before each single-pulse stimulation of the hippocampus, the excitatory responses of the silent and spontaneously active accumbens neurones were attenuated. The possibility of this relatively prolonged attenuation effect being dopamine-mediated was supported by several lines of evidence. Dopamine, applied iontophoretically, reduced markedly the excitatory response of accumbens neurones to hippocampal stimulation. Iontophoretically applied dopamine mimicked the attenuating effect produced by VTA conditioning stimulation in the same neurone. The attenuating effects of VTA conditioning stimulation on the activation of accumbens neurones by hippocampal stimulation was reduced by: (1) administration of 6-hydroxydopamine to the VTA 2 days and 7-9 days prior to the recording session, (2) the intraperitoneal injection of haloperidol 1 h before the recording session, and (3) the iontophoretic application of trifluoperazine to accumbens neurones. These observations support the hypothesis that the attenuating effects of the mesolimbic dopamine system on limbic inputs to the nucleus accumbens may have a role in limbic-motor integration.

The highly purified, molybdate-stabilized '8-9-S' form of the chick oviduct progesterone receptor complexed with [3H]progesterone (Specific activity approximately equal to 10-12 nmol bound steroid/mg protein) was prepared according to the three-step method [Renoir et al. (1982) Eur. J. Biochem. 127,71-79] and 50-90 micrograms samples were injected into a goat and a rabbit. Specific antibodies were observed as early as 2 weeks following the first booster injection and increased considerably 12 weeks later after further booster injections. Results were similar in the two animals, with higher titers observed in the goat. Antibodies cross-reacted with the 'transformed' 4-S form of the chick oviduct progesterone receptor. They also cross-reacted with molybdate-stabilized 8-9-S progesterone receptors of mammalian species (obtained from MCF-7 human breast cancer cells and from rabbit and mouse uteri), suggesting some evolutionary conservation of steroid hormone receptors. No cross-reaction was observed with chick oviduct oestradiol receptor and with chick plasma transcortin (a non-receptor progesterone-binding protein).

An intracavernous injection with papaverine or prostaglandin E1 (PGE1) combined with duplex ultrasonography is an objective technique to conduct a penile blood flow study (PBFS). Three hundred patients with impotence underwent papaverine (9-60 mg) induced PBFS at the University of California School of Medicine, San Francisco (UCSF), U.S.A. and another 80 patients with impotence received PGE1-induced (20 micrograms) PBFS at Veterans General Hospital-Taichung (VGH-TC), R.O.C. Preliminary evaluation of age, duration of disease and pre-injection diameter of cavernous arteries disclosed no significant difference in these 2 series. It was interesting to find that almost all parameters of vascular response to pavaverine vs PGE1 differed significantly, such as onset of response (6.5 +/- 6.5 vs 11.7 +/- 6.4 min, slower in the PGE1 group, p less than 0.001); post-injection diameter of cavernous arteries (right: 0.73 +/- 0.20 vs 0.79 +/- 0.18 mm, p = 0.03; left: 0.74 +/- 0.20 vs 0.82 +/- 0.21 mm, p = 0.005); diametral increment of cavernous arteries (right: 0.23 +/- 0.17 vs 0.33 +/- 0.17 mm, p less than 0.001; left: 0.24 +/- 0.17 vs 0.36 +/- 0.19 mm, p less than 0.001) and peak velocity (right: 27.5 +/- 16.1 vs 42.0 +/- 20.1 cm/sec, p less than 0.001; left: 28.9 +/- 15.9 vs 39.7 +/- 17.9 cm/sec, p less than 0.001). The side effects, primarily injection pain (23.8%, 19/80) in the PGE1 group and dizziness (3.0%, 9/300) in the papaverine group, were minor in these 2 series. Prolonged erection was not encountered in either series; however, immediate treatment was performed if a papaverine-induced erection lasted over 60 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

The possible role of ventral pallidum (VP) in expressing dopaminergic actions in the nucleus accumbens was studied electrophysiologically using extracellular single unit recording and iontophoretic techniques in urethane-anaesthetized rats. Microinjections of dopamine (130 mM, 5-10 micrograms/0.2-0.4 microliters) into the nucleus accumbens resulted in a gradual, but prolonged, increase in the firing rate of VP neurones. Injections of the D1 agonist SKF38393 (34 mM, 2 micrograms/0.2 microliters), followed by the D2 agonist quinpirole (40 mM, 2 micrograms/0.2 microliters) into the accumbens, but not in the reverse order, resulted in a similar increase in the activity of VP neurones, mimicking the dopaminergic effect. Injections of either the D1 or the D2 agonist alone into the accumbens, however, produced no significant changes. Furthermore, iontophoretic application of picrotoxin, a gamma-aminobutyric acid (GABA) antagonist, or naloxone, an opiate (including enkephalin) antagonist on the same VP neurone which responded to accumbens dopamine injection also increase its spontaneous firing rate. Thus, pre-activation of D1 receptors in the accumbens was essential for the subsequent physiological expression of D2 receptors in inducing an increase in the firing rate of VP neurones. Dopamine in the accumbens may suppress the tonic inhibitory GABAergic and enkephalinergic outputs to the VP, resulting in an increase in firing rate of VP neurones. Since previous behavioural studies have shown that dopaminergic stimulation in the accumbens increases locomotor activity, the increased firing rate of ventral pallidal neurones may be expressing the postsynaptic actions of dopamine receptor stimulations in the accumbens as initiation of locomotor activity.

We screened 80 patients at our hospital for the differential diagnosis of impotence using intracavernous injection of prostaglandin E1 (20 micrograms). The rate of positive response was 78.8 per cent (63 patients). Neither systemic reactions nor priapism occurred. However, a considerable incidence (23.8 per cent, 19 of 80 patients) of tolerable injection pain was encountered. The 133xenon penile washout study was conducted routinely in impotent men for hemodynamic evaluation of penile vascularity. In 80 patients a positive correlation between the response of intracavernous prostaglandin E1 injection and the result of the washout study was found (r equals 0.381, p less than 0.0002). We selected 14 subjects randomly to receive additional intravenous infusions of prostaglandin E1 (6 ampules, 120 micrograms total) for 3 days, after which another 133xenon washout study was done. The washout studies before and after intravenous prostaglandin E1 infusion were compared, and 10 patients (71.4 per cent) appeared to obtain improvement in half-time clearance and penile blood flow. However, only 3 patients noticed improvement subjectively. We suggest that prostaglandin E1 could be a desirable alternative for the diagnosis and treatment of impotence.