Immunohistochemical demonstration of secretory IgA in human urothelium.

The mucosal surface of the human urothelium represents a very large exposure area to exogenous agents, including potentially harmful microorganisms. Male human urothelium was treated for the immunohistochemical demonstration of secretory IgA (sIgA) in order to verify its own possible antimicrobial properties. An intense immunoreactivity for sIgA was observed in the apical cells of the urethral and vesical epithelia. The ureteric epithelium, at the luminal surface, showed discontinuous areas of less dense or completely absent reaction product. A less intense immunoreactivity was observed in the pelvic apical epithelial cells. The results suggest that sIgA play a prominent role in the local defence mechanisms of the lower urinary tract against ascending infections, whereas in the upper urinary tract the immuno-specific local defences seem reduced.

Cytogenetic investigation on 30 bladder carcinomas.

Cytogenetic study of 30 bladder carcinomas confirmed the heterogeneity and the complexity of the karyotypic picture in this type of tumor. Presence of numerical and/or structural chromosome aberrations was observed in all tumors. Clonal abnormalities were found in 19 cases. Chromosomes most frequently involved in changes were chromosome #1, #3 and #11(36.6%, 26.6%, and 20% of the cases respectively). Trisomy 7 and monosomy 9 were the sole abnormalities in one case each.

Derivative 11 marker chromosome in bladder carcinoma.

Cytogenetic studies on bladder carcinomas from two patients were carried out on preparations obtained by a direct method. The chromosome mode was 49 and 55, respectively. Several karyotypic changes were found in the tumors. Moreover, the analysis of Q-banded chromosomes revealed the presence in both cases of a chromosome 11p+. These rearranged chromosomes showed a very similar banding pattern. The finding of a der(11) chromosome marker in two patients is intriguing, and suggests the possibility of nonrandom chromosome changes in bladder carcinoma, as already found in other kinds of tumors. The occurrence of chromosome #11 aberrations in tumors of the urinary tract is discussed in connection with the current theories on oncogenesis.

Urolume double prosthesis in the treatment of complex urethral strictures: a 5-year follow-up case report.

The 5-year follow-up of the implantation of a UroLume double urethral stent in 2 patients with recurrent, post-traumatic urethral strictures is presented. The double implantation for each patient was done by the long extension of the urethral lesion. Only 1 patient presented a single phosphatic concretion in the implantation area during the extended follow-up. Urinary flow rates remained absolutely normal. Sexual life was unaffected. This simple modification of the UroLume implantation may offer effective treatment for extended and recurrent posterior urethral strictures in young sexually active men, for almost 5 years without early or delayed complications of clinical relevance.

Ureterolithotripsy in children.

OBJECTIVES: The pediatric application of ureteroscopy was initially hindered by the size of the instruments and the fear of damaging the urethra and ureterovesical junction during endoscopic maneuvers. This review of our experience is focused on the usefulness of thin and ultrathin ureteroscopes such as the 7 F Gautier rigid ureteroscope with rod lens optics (Wolf) or the new, ultrathin 4.8 F Wolf ureteroscope, semirigid, fiberoptic, in conjunction with atraumatic sources of energy such as pulsed dye laser or ballistic lithotripter, for the treatment of ureteral stones in children. METHODS: Between 1989 and 1994, we performed ureteroscopy and ureterolithotripsy on 7 children less than 10 years old. There were 6 male patients and 1 female patient, with a mean age of 6 years (range, 3.5 to 10). We used the pulsed dye laser Pulsolith and the ballistic lithotripter Lithoclast, the Gautier (Wolf) rigid, rod lens ureteroscope (7 F), without the sheath or the blunt needle 4.8 F semirigid (Wolf), fiberoptic ureteroscope. In all cases a double pigtail ureteral catheter was left in situ. RESULTS: In all 7 cases, the treatment was successful without early or delayed complications. In particular, no case of vesicoureteral reflux was observed in any of the children during subsequent follow-ups. CONCLUSIONS: This article demonstrates the feasibility of ureteroscopy and ureterolithotripsy in children less than 10 years old with ureteral stones. We believe that because of the fragility of the ureter in the pediatric age group, ureteroscopic maneuvers should be performed and handled by experienced endourologists in well-equipped centers.

Histochemical demonstration of glucose-6-phosphate dehydrogenase, D-sorbitol dehydrogenase, and alkaline phosphatase in human ampulla ductus deferentis.

A cytochemical study on the localization of the enzymes glucose-6-phosphate dehydrogenase, sorbitol dehydrogenase, and alkaline phosphatase was carried out in human ampullary glands. Although the former two enzymes showed a marked reactivity, alkaline phosphatase was absent from epithelial cells. On the basis of these results it is concluded that, as in the human seminal vesicle, in the ampullary gland fructose is probably secreted via the oxidative mechanism proposed by Hers (Le Metabolisme du Fructose. Bruxelles, Arscia, 1957).

The human bulbo-urethral glands. A transmission electron microscopy and scanning electron microscopy study.

This paper investigates the ultrastructure of human bulbo-urethral glands using specimens obtained at surgery. The tubulo-alveolar endpieces of these glands are lined by typical mucous cells in different stages of the secretory cycle. The most interesting features of their cytoplasm are membrane-bounded bodies with a filamentous texture that usually fuse with the mucous droplets before they discharge into the lumen. Cells with apical dark granules are sometimes encountered in the ductal portions of the gland, which are probably ductal cells endowed with a scanty synthetic and secretory activity. Myoepithelial cells are not very numerous and are observed around mucous cells only.

Diffuse lymphoid tissue associated with the human bulbourethral gland. An immunohistologic characterization.

This study investigates the presence and distribution of immunocompetent cells in bulbourethral glands obtained from four multiorgan transplant donors. Monoclonal antibodies reacting with B (Leu 12+) and T (Leu 4+) cells, suppressor-cytotoxic cells (Leu 2+), helper-inducer (Leu 3a+) and natural killer (Leu7+) phenotypes, monocyte-macrophages, (LeuM3+), and cells expressing interleukin-2 receptor and HLA-DR antigen were tested in all specimens using an indirect immunoperoxidase staining procedure. T lymphocytes were estimated to represent 10% of the mucosal cell population. Almost all intraepithelial lymphocytes were suppressor-cytotoxic (CD8+) cells. The results demonstrate the presence of a defined distribution of immunocompetent cells in these sex accessory glands. Their role in combatting infections or other chronic genitourinary diseases is still undefined.

Is there a role for adjuvant immunochemotherapy after radical nephrectomy in pT2-3N0M0 renal cell carcinoma?

Five-year overall survival after radical surgery in N0M0 renal cell carcinoma varies from 45-80% in pT2 to 35-50% in pT3 categories. In view of the alpha interferon and vinblastine combination which has shown some activity in advanced disease with increasing efficacy in limited metastatic invasion, we decided to explore the theoretical advantage of adjuvant chemo-immunotherapy in radically resected stage II, III renal cell carcinoma. A single-institution phase II study was undertaken to evaluate the efficacy and tolerability of alpha 2a-interferon (alpha 2a-INF) in combination with vinblastine in 30 patients with pT2-T3 N0M0 renal cell carcinoma (RCC). Thirty-two patients who received only radical nephrectomy and extended lymphadenectomy were analyzed and results were compared with the first group. Twenty-three of 30 (76.6%) patients in the first group are alive with no evidence of disease. The median follow-up for the 23 patients still alive was 67 months (range 60 to 72). Metastases were documented in 5 patients (16.6%) with a median interval to progression of 24 months. Four of them (13.6%) died of tumor. In the control group, 16 out of 32 patients (50%) are still alive, with a median follow-up for the patients still alive of 62 months (range 60 to 68). Fifteen patients developed distant metastases and 2 of them had a local recurrence. All of them (46.8%) died of tumor. Median progression interval was 24 months. After stratification by pathological grade, site, laterality and number of nodes found at lymphadenectomy there were no statistical differences in risk of progression or death in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Metastatic renal cell cancer treated with recombinant alpha 2a interferon and vinblastine.

42 patients with advanced renal cell carcinoma were treated with a combination therapy with interferon alpha 2a (mean dosage 16 x 10(6) U i.m. 3 times/week) and vinblastine (0.1 mg/Kg every 21 days). 12 patients (28.5%) had a positive response. Of them 1 presented a complete response (2.38%), 5 a partial response (11.9%) and 6 a stable disease (14.2%). No significant side effects were observed apart from the flu-like syndrome (all patients) and a moderate leukopenia (45.2%). The median duration of responses was 10+ months (range 3-37 months). At 4-year follow-up the median survival time was 16.0 months (range 4-37 months).

Chromosome changes in renal cell carcinoma.

Cytogenetic studies have provided a great deal of useful information about the biology and diagnosis of renal cell tumors. Particularly papillary and non-papillary tumors seem to be characterized by different cytogenetic patterns. We report the cytogenetic and histologic analysis of 16 renal tumors, 5 of which showed clonal chromosome changes. Most had chromosome abnormalities which have so far been described as specific of particular histopathologic subgroups.

[Treatment of urinary infections with ticarcillin and clavulanic acid (Clavucar) by the intramuscular route]. / Trattamento delle infezioni urinarie con ticarcillina ed acido clavulanico (Clavucar) per via intramuscolare.

20 patients suffering from hospital-acquired UTI received intramuscularly ticarcillin 1 g and clavulanic acid 200 mg for 8 days. At the end of antimicrobial therapy 84.2% of the pts presented sterile urine. After 2 weeks 68.4% of the pts continued to have sterile urine. No significant side effects were registered. The results demonstrate that the association of ticarcillin with clavulanic acid can be considered a useful option in hospital acquired UTI.

[Ureteroscopic lithotripsy using the laser]. / La lithotrite urétéroscopique au laser.

The Cagliari urology team is very satisfied with the use of the dye laser for ureteroscopic lithotripsy. This apparatus is recommended in units possessing a well equipped endourology room, otherwise it is simpler to use endoureteric ballistic lithotripsy, which also provides good results.

[Temporary retrograde and anterograde ureteral catheterization]. / Sondage urétéral temporaire rétrograde et antérograde.

This article examines the technical modalities or ureteral catheterization. The authors also discuss unconventional modalities which, if used without prejudice, can sometimes constitute brilliant and economic solutions to complex problems which are often impossible to resolve otherwise. After a summary of the history of ureteral catheterization, the authors present the main indications for temporary ureteral catheterization: radiographic and fluoroscopic examination of the ureter; separate cytological harvesting; separate bacteriological harvesting; confirmation of the side of unilateral haematuria; preliminary temporary dilatation of the ureter to prepare it for ureteroscopy; temporary drainage of the excretory tract after endourological investigation. The authors also present particular situations may be observed temporary catheterization, or even permanent stenting, for example in the case of procedures in children, pregnant women and renal transplant recipients.

[Four corner bladder base and bladder neck suspension with intraosseous anchorage in the treatment of moderate cystocele]. / La sospensione della base e del collo vescicale ai quattro angoli con ancoraggio intraosseo per la correzione del cistocele moderato.

During the last 10 years the original Pereyra technique of needle bladder neck suspension has been object of more than 36 modifications with the goal to improve long term results and to enhance feasibility. It represents also a part of the so called four corner bladder and bladder neck suspension (anterior suspending sutures) which is at present a reliable and durable manner to manage mild to moderate cystocele; this procedure reestablishes safely and simply support to bladder base, bladder neck and urethra preventing the onset of a denovo stress urinary incontinence. Complications include post-operative pain which could represent a problem in about 16% of the patients: it has been related to the entrapment of the ileoinguinal nerve between prolene sutures and rectus fascia and may be responsible of a delay in the re-establishment of a normal voiding pattern due to the pain elicited during any rectus muscle contraction. We propose a refinement of this procedure which includes the osseous anchoring of the suspending suture through the Mitek G II anchor system. Reduction in postoperative pain and fast recovery of a normal voiding pattern soon after surgery seems to be the most important result of this modification. Osteitis pubis has not been noted. Any improvement in long term durability of the procedure has not yet been determined due to the short follow-up and limited series of cases and the need for subsequent long term follow-up.

Simultaneous enzymatic synthesis of FAME and triacetyl glycerol from triglycerides and methyl acetate.

In the presence of methyl acetate triglycerides such as vegetable oils are transformed simultaneously into the corresponding fatty acid methyl esters and triacetyl glycerol (triacetin). The reaction, catalyzed by lipases, was studied as a function of some critical parameters, such as type of catalyst, enzyme hydration and immobilization support. The aim of the work was to achieve a conversion of the triglyceride as high as possible and to maximize the yield of the triacetin, the reaction end point. It was found that by using the immobilized lipase from Candida antarctica yields as high as 80% of both fatty acid esters and triacetin could be achieved. These results were obtained by carefully controlling the amount of water present in the reaction medium and the hydration level of the enzyme macromolecule.