Quantification of the Na+/K(+)-pump in solubilized tissue by the ouabain binding method coupled with high-performance gel chromatography.

Membrane-bound Na+/K(+)-ATPase purified from dog kidney outer medulla was solubilized with octaethylene glycol n-dodecyl ether (C12E8) and incubated with [3H]ouabain in the presence of NaCl. ATP and MgCl2 for 10 min at 0 degrees C. The resulting enzyme was separated, by high-performance gel chromatography executed at 0.2 degrees C. Mainly into its (alpha beta)2-diprotomer and alpha beta-protomer, which both bound stoichiometrically to [3H]ouabain. The amounts of ouabain that bound to the tissue itself and its microsomes could be estimated in the same way, as [3H]ouabain was found to bind only to the diprotomer and protomer they possessed. The amounts of ouabain that bound to them in the solubilized state were at least 5-times higher than those that did so when they were non-solubilized, suggesting that the surfactant rendered the enzyme accessible to ouabain. When the solubilized tissue (138 mg ml-1 wet tissue) was reacted with ouabain in the presence of 0.1 M NaCl and 4.8 mM MgCl2 for 10 min at 0 degrees C, maximal ouabain binding was attained in the presence of 18.3 microM [3H]ouabain, 1.2 mM ATP and 3 to 5 mg ml-1 C12E8, which was common to the outer medulla and human colon cancer cells. The present method enabled the pump number in protein and tissue samples in the range 7.2 x 10(-9) (purified pump) to 1.5 x 10(-12) (cancer tissue) mol/mg protein to be estimated within 2 h.

Urinary dopamine excretion in normotensive subjects with or without family history of hypertension.

To define the role of the renal dopaminergic system in the pathogenesis of essential hypertension, urinary free dopamine excretion was examined in 23 normotensive subjects who had one or more first-degree relatives with essential hypertension, and also in 36 matched control subjects without any such family history. The group urinary dopamine excretion and urinary sodium excretion were not different. However, a significant urine dopamine-sodium relationship was apparent in the controls but not in the relatives due to relatively high dopamine output in those with lower sodium excretion. The two groups were similar as regards blood pressure (BP), plasma renin activity (PRA), prolactin and catecholamines. These findings demonstrate an alteration in the urine dopamine-sodium relationship in some normotensive subjects with genetic risk of hypertension.

Plasma prolactin, renin and catecholamines in young normotensive and borderline hypertensive subjects.

It has been reported that patients with essential hypertension have high plasma prolactin levels and suggested that reduced central dopaminergic activity may be a factor in the pathogenesis of essential hypertension. This study examines the influence of posture on plasma prolactin, plasma catecholamines, plasma renin activity, blood pressure and heart rate in 24 patients with borderline hypertension (age 19 +/- 1 years) and 20 normotensive subjects matched for age and body mass index. Supine plasma prolactin levels were similar in both groups [borderline hypertension, 11.3 +/- 0.7 ng/ml; normotensive, 10.7 +/- 0.8 ng/ml (mean +/- s.e.m.)] and no increase in plasma prolactin was observed after 10 min standing in both groups. Normotensive and borderline hypertensive subjects had similar values for supine and upright plasma renin activity and plasma norepinephrine. There were no significant correlations between supine plasma prolactin and supine blood pressure, supine plasma renin activity or plasma norepinephrine when data from both normotensive and borderline hypertensive subjects were combined. These results may provide indirect evidence against the occurrence of reduced central dopaminergic activity in borderline hypertension.

Leisure time physical activity and insulin resistance in young obese students with hypertension.

To investigate the hypothesis that insulin resistance plays a role in the etiology of hypertension and hyperlipidemia, we measured serum lipid levels, the fasting glucose/insulin ratio, and the insulin response to oral glucose (GTT) in a group of young obese subjects (n = 21) with hypertension and normal glucose tolerance and in normotensive subjects (n = 36) with normal glucose tolerance, matched for age and body mass index. Leisure time physical activity was evaluated by a questionnaire outlining three levels of physical activities during leisure time. Subjects with hypertension had higher fasting serum insulin (19 +/- 2 v 13 +/- 1 microU/mL, P < .01) and lower fasting glucose/insulin ratio (5.3 +/- 0.2 v 7.1 +/- 0.5 mg/dL/microU/mL, P < .01) than normotensive subjects. Subjects with hypertension had higher peak serum insulin and lower plasma glucose area/insulin area ratio in response to glucose (1.8 +/- 0.2 v 2.4 +/- 0.2 mg/dL/microU/mL, P < .05) than normotensive subjects. Serum total cholesterol, low-density cholesterol, and triglycerides were higher in the obese hypertensive subjects than in obese normotensive ones. Blood pressure correlated with either fasting serum insulin, fasting glucose/insulin ratio, or glucose area/insulin area ratio during GTT. The level of leisure time physical activities was lower in obese hypertensive subjects than in obese normotensive ones. There were significant correlations between the levels of physical activity and the fasting plasma glucose/insulin ratio (r = 0.371, P < .01) or the fasting serum insulin concentration (r = -0.282, P < .05). The study provided evidence that a low level of leisure time physical activity is associated with insulin resistance and resultant hyperinsulinemia, which are the key metabolic abnormalities that link hypertension, obesity, and hyperlipidemia in young subjects.

Comparison of clinic and home blood pressure levels and the role of the sympathetic nervous system in clinic-home differences.

Plasma and urine norepinephrine, epinephrine and home blood pressure were measured in 48 young hypertensive men (mean age, 21 years) and 25 matched normotensive controls. Plasma samples were drawn following 30 min rest in the clinic and 24 h urine samples were collected at home. Twenty-one hypertensive patients were given a single dose of clonidine (150 micrograms orally). Changes in blood pressure, heart rate and plasma norepinephrine were assessed. Twenty-five of the hypertensive patients were found to have a normal home blood pressure (defined from records of the normotensive subjects). The other group of patients maintained a high home blood pressure. In comparison to normal subjects, patients with a high home blood pressure were characterized by higher urinary norepinephrine and epinephrine excretion and higher plasma epinephrine. Patients with a normal home blood pressure had normal heart rate at home, normal plasma and urinary catecholamines. However, the two groups of hypertensives could not be distinguished on the basis of clinic blood pressure, plasma or urinary catecholamines due to considerable overlap. At 90 min after oral clonidine administration, the plasma norepinephrine and blood pressure levels were decreased in both groups of hypertensives to a similar extent. The changes in heart rate were significantly smaller in patients with a high home blood pressure than in those with a normal home blood pressure. These results suggest that the patients with a high home blood pressure tended to have a high sympathetic nerve activity. However, the two groups of hypertensives could not be separated on the basis of plasma or urinary catecholamine measurements.

The role of intraabdominal pressure in venous blood drainage from the prostate into the vertebral vein system.

We investigated venous blood drainage from the prostate into the vertebral vein system by cineangiography in five mongrel dogs and measured intraabdominal pressure and venous blood pressure in the dog or human to study the role of intraabdominal pressure in the drainage. The averages of intraabdominal pressure and caudal vena caval pressure in the dog were 32.2 +/- 3.0 and 12.8 +/- 1.3 mmHg, respectively, in the supine position, and 39.2 +/- 3.0 and 23.8 +/- 4.0 mmHg, respectively, in the head-up tilt position, when the radiopaque medium injected into the dorsal penile vein appeared in the vertebral vein system. Intraabdominal pressure in the head-up tilt position was significantly higher than that in the supine position when the venous drainage into the vertebral veins happened. In eight continuous ambulatory peritoneal dialysis patients, intraabdominal pressure showed 8.1 +/- 2.4 mmHg in the supine position, 24.6 +/- 4.3 mmHg in the sitting position, and 30.4 +/- 4.9 mmHg in the standing position at rest. During voluntary contraction of the abdominal muscles, the pressure was increased up to 50.6 +/- 21.6 mmHg in the supine position, 69.3 +/- 19.8 mmHg in the sitting position, and 73.8 +/- 19.8 mmHg in the standing position. These pressure values in the human were significantly higher than those observed at the time when the radiopaque medium appeared in the vertebral veins in both supine and head-up tilt positions in the canine. These results suggest that the increase of intraabdominal pressure causes inflow of prostatic venous blood into the vertebral veins via the inferior vena cava, common iliac vein, or internal iliac vein.

Blood pressure response to a calcium entry blocker in normotensive subjects with or without a family history of hypertension.

The possibility that a familial background of hypertension might influence the blood pressure response to a calcium entry blocker was evaluated in 15 normotensive relatives of patients with essential hypertension and 18 normotensive subjects with no family history of hypertension. Under control conditions, blood pressure, heart rate, plasma noradrenaline, adrenaline, and renin activity did not differ between the two groups. Nifedipine, at a dose of 10 mg administered sublingually, lowered the blood pressure and increased the heart rate, plasma noradrenaline, and renin activity. The normotensive relatives of patients with essential hypertension did not differ in their responses from the normotensive subjects with no family history of hypertension, with the exception of plasma noradrenaline thirty minutes after nifedipine. These results provide evidence to suggest that there is no functional abnormality with increased dependency of vascular smooth muscle tone on calcium influx in the prehypertensive state.

Effect of captopril on plasma prolactin in patients with essential hypertension.

The effects of the angiotensin-converting enzyme inhibitor captopril on blood pressure, heart rate, plasma prolactin, and renin activity were examined in a single-blind, placebo-controlled trial on 30 patients with essential hypertension (15 given drug, 15 placebo). Captopril, 25 mg administered orally, reduced the blood pressure and increased the plasma renin activity. Captopril decreased mean plasma prolactin from 17.5 +/- 1.4 ng/mL to 9.1 +/- 1.0 ng/mL (p less than 0.001). Significant correlation was found between captopril-induced change from control values of plasma prolactin (delta plasma prolactin) vs delta plasma renin activity (r = -0.688, p less than 0.001). These results suggest that acute administration of captopril was accompanied by a reduction in plasma prolactin and that this reduction may be of clinical significance during therapy of hypertension.

Effect of L-dopa in young patients with hypertension.

The effects of L-dopa on blood pressure, heart rate, plasma renin activity, norepinephrine, epinephrine and prolactin were studied in a randomized single-blind trial in 36 patients with essential hypertension. In response to L-dopa, 250 mg administered orally, the blood pressure decreased significantly as compared with the results of placebo treatment. The heart rate and plasma norepinephrine and epinephrine were unchanged. The plasma renin activity and prolactin decreased as a result of L-dopa administration. The administration of a peripheral DA2 dopamine receptor blocker, domperidone (20 mg, orally) prevented the L-dopa-induced reduction in plasma prolactin but failed to block the fall in blood pressure and plasma renin activity. These results suggest that the blood pressure-lowering effect of L-dopa may be mediated through multiple sites involving D1 dopamine receptors, the central nervous system, and the renin-angiotensin system.

[Vesicorectal fistula associated with Crohn's disease: a case report].

A 41-year-old man was hospitalized, complaining of fecaluria and right lower abdominal pain. He was diagnosed to have vesicorectal fistula. Wedge resection of bladder and rectum, and partial resection of ileocecal legion were performed. Pathological diagnosis was Crohn's disease. Postoperative course was uneventful and no recurrence was observed. Including our case, 32 cases of enterovesical fistula due to Crohn's disease have been reported in the Japanese literature.

[Unilateral hydronephrosis with hypertension due to ureteral endometriosis].

A 35-year-old female patient was hospitalized for a headache. She was referred to our department for the evaluation of right hydronephrosis noted on the excretory urogram which was performed as part of a hypertensive diagnostic study. Endocrine examination revealed renal hypertension. Excretory urogram and antegrade pyelography showed obstruction of the lower part of the right ureter. On surgical exploration, the lower part of the right ureter was surrounded by brown tissue. Complete hysterectomy and ureterovesiconeostomy were performed. Histologically, the brown tissue around the ureter was diagnosed as endometriosis. One year after the operation, excretory urogram showed normal urinary tract and the blood pressure was 130/80 mmHg. Endometriosis is a common gynecological disease but ureteral endometriosis is relatively rare. Review of the Japanese literature disclosed 16 previous cases of ureteral endometriosis and we report the 17th case with a review of the literature.

[Transitional cell carcinoma of the ureter with an inverted growth pattern which was accompanied with bladder tumor: a case report].

The patient was a 75-year-old man who complained of macrohematuria which had set in from April 12, 1988. Under the clinical diagnosis of bladder tumor, total cystectomy with ureterosigmoidostomy was performed on June 25. During his surgery, we discovered a polypoid lesion of the right ureter close to the common iliac artery. The tumor was peanut-sized and had a stalk suggesting benign nature, so we resected it. Postoperative pathological examination revealed the tumor was transitional cell carcinoma (grade 2) with an inverted growth pattern. Though we could find no signs of tumor recurrence, the presence of tumor's residuum could not be ruled out. We performed nephroureterectomy of the right side on December 19. Follow-up on July 1, 1989 this patient revealed no tumor recurrence.

[A case of shock following intravesical formalin instillation].

A case of shock following intravesical formalin instillation for massive bladder hemorrhage owing to post-radiation cystitis is reported. A 79-year-old woman had been treated with external irradiation for cancer of the uterine body in 1981. She was suffering from massive hematuria after hysterectomy in 1988. No hemostatic procedures were effective. Then we instilled 10% formalin into her bladder. After the instillation she entered a state of allergic shock.

[Ectopic parathyroid adenoma: a case report].

A 69-year-old woman suffered from bilateral renal stones. Laboratory examinations showed primary hyperparathyroidism. Neck exploration including left hemithyroidectomy and partial thymectomy failed to reveal the abnormal parathyroid gland. Localization studies were done for an ectopic parathyroid adenoma. Repeated selective arteriography with digital subtraction technique revealed an ectopic parathyroid adenoma in the upper mediastinum. Computed tomography, ultrasonotomography and selective venous sampling also confirmed this finding. Subsequently, mediastinal exploration with partial sternotomy was performed and the ectopic parathyroid adenoma was removed. We discuss the preoperative localization studies for ectopic parathyroid adenoma.

[Retroperitoneal lymph node dissection for testicular tumor with renal autotransplantation: a case report].

A case of testicular tumor (embryonal cell carcinoma with choriocarcinoma) in a 42-year-old man treated with renal autotransplantation is presented. After four courses of chemotherapy (carboplatin, vinblastine and bleomycin), we performed retroperitoneal lymph node dissection. At the operation, one of the swelling lymph nodes involved left renal artery completely, so we performed left renal autotransplantation and promoted more effective lymph node dissection. After the operation, renal function was impaired but returned completely in a short time. Autotransplantation provides excellent bench visualization of renal lesions and stable graft function. Therefore, this procedure should be taken into consideration when nephrectomy cannot be avoided.

[Study of voiding disturbances in elderly males. III. Analysis of flow rates and patterns in uroflowmetric studies: comparison between children, young adults and elderly men].

We performed uroflowmetric study in 8 boys (7 approximately 14 years old), 20 young adults (19 approximately 39 years old) and 552 elderly men (40 approximately 93 years old) with a DISA 21C10 mictiometer, and obtained 753 studies. Uroflowmetric studies were classified into 6 patterns: N type (normal), NB type (neurogenic bladder: wave-like curve), OB type (obstructive diseases: flat curve), AP type (anterior peak), PP type (posterior peak) and OT type (others). We studied the relationship between age and uroflowmetry with patterns and flow rates (maximum flow rate = MFR, average flow rate = AFR). In men over 19 years old, flow rates (MFR, AFR) decreased proportionally with age (MFR: 2.9 ml/s/10 years old, AFR: 1.6 ml/s/10 years old). In elderly men (over 40 years old), the N type flow curve decreased and OB type flow curves increased gradually with age.

[Symptoms and signs of benign prostate hypertrophy (BPH)].

Clinical characteristics of BPH were investigated in the relationship among prostate volume estimated by transrectal sonography, symptoms by questionnaire, residual urine volume, and voiding force evaluated by uroflowmetry. There was no apparent relationship among them, which might be caused by the poor reproducibility of residual urine volume, the difficult enumeration of the symptoms, contamination of other diseases of which voiding disorder is correlated with aging and other unknown factors. Under such a situation, this disease should be treated as a BPH syndrome. Moreover we propose that BPH syndrome should be classified into three types; type 1: symptomatic BPH without enlarged prostate, type 2: asymptomatic BPH with enlarged prostate and type 3: symptomatic BPH with enlarged prostate.

[Clinical study on prostate cancer initially presenting with disseminated intravascular coagulation syndrome].

We experienced five patients with prostate cancer with disseminated intravascular coagulation syndrome (DIC) at the first presentation at Gunma University Hospital and affiliated institutions between 1991 and 1997. Their average age was 68 years, average DIC score at the first presentation was 10 and prostate specific antigen (PSA) level was more than 700 ng/ml. All of them had multiple bone metastases. The therapy for DIC and hormonal therapy for prostate cancer were simultaneously started at the first presentation before prostate needle biopsy, but all patients died. The average number of days from the start of DIC to death was 685 days. The patients initially showed a good response to therapy, but their conditions soon aggravated. The prognosis was extremely poor, but some proper therapies lead to the prognosis which was equal to that of prostate cancer in Stage D2 without DIC.

High postprandial plasma remnant-like particles-cholesterol in patients with coronary artery diseases on chronic maintenance hemodialysis.

The aim of this study was to determine the levels of postprandial plasma remnant-like particles-cholesterol (RLP-C) in patients with coronary artery disease (CAD) on chronic maintenance hemodialysis (HD). Forty-two patients on chronic maintenance HD with and without CAD were studied. The subjects took a meal within 1 hr before HD then underwent HD for 4 hr with heparin infusion. The plasma level of RLP-C was monitored before and during HD and its biochemical characteristics were analysed. In the CAD group, the RLP-C level was 5.9 +/- 3.5 mg/dl before HD and 6.9 +/- 4.6 mg/dl after HD. In patients without CAD, RLP-C levels before and after HD were 2.1 +/- 0.8 mg/ dl and 2.7 +/- 1.2 mg/dl respectively (within the normal range). The RLP-C levels between CAD and non-CAD were highly significant (p < 0.001). HPLC analysis of RLP revealed that VLDL remnants were reduced to smaller size, cholesterol rich particles within 1 hr of HD and a marked increase in chylomicron (CM) remnants was observed at the end of HD. These observations suggest that a latent metabolic disorder of chylomicrons and VLDL during HD after a meal can be detected by plasma RLP-C assay. The association between the frequency of latent metabolic lipoprotein disorders and CAD found in HD patients may require appropriate dietary intervention together with drugy therapy for the control of CAD.

[Double filtration plasma pheresis was effective on the recurrence of pulmonary hemorrhage after renal transplantation: report of a case].

A 35-year old female with an autoimmune disease complaining of recurrent hemoptysis and macrohematuria had received a renal transplantation from her mother. After transplantation, recurrence of pulmonary hemorrhage occurred twice. First recurrence followed the peritonitis with ileal perforation. Steroid pulse therapy had no effect on this recurrence, while double filtration plasmapheresis was effective. During this treatment, renal function was not failed. Second recurrence followed acute rejection that was cured with the OKT3-rescue therapy. DFPP therapy was effective on this episode. Pulmonary hemorrhage was caused by auto immune reaction and acute rejection caused by transplant immune reaction were recognized independently, and they needed different treatment. According to this clinical course, we consider the relation between auto immune reaction and transplant immune reaction was as follows. T cell activation caused by primary transplant immune reaction may have no direct influence on auto immune reaction. Peritonitis and rejection may induce auto immune reaction. We suppose that this auto immune reaction was caused by humoral factor, because auto immune reaction was controlled by DFPP.