Carbonate in struvite stone detected in Raman spectra compared with infrared spectra and X-ray diffraction.

BACKGROUND: In regard to identify the compositions of urinary stones, the infrared spectra is a contemporary routine method. However, it is difficult to detect the absorption of carbonate in struvite stone by infrared spectra, because NH4 absorption of magnesium ammonium phosphate overlaps CO3 absorption of carbonate at 1420-1435 cm-1. With the purpose of demonstrating the existence of carbonate in struvite stones, the analysis of these stones by means of Raman spectra has been tried. METHODS: Forty urinary stones, the chemical compositions of which were previously determined by infrared spectroscopy, were submitted to Raman spectrum analysis, and subsequently to analysis by x-ray diffraction. RESULTS: Thirty of 40 urinary stones were found to be composed of struvite and of mixed struvite-calcium oxalate by infrared analysis. Twelve of these stones were shown to have Raman spectra of magnesium ammonium phosphate, and the other stones to have spectra of apatite. By x-ray diffraction magnesium ammonium phosphate crystals were detected in 25 of these struvite stones and hydroxyl-apatite in another 3, and 2 cases were undeterminable. For other components, such as calcium oxalate, uric acid and cystine, the analytical results of infrared spectra coincided with those of Raman spectra and x-ray diffraction. Carbonate was detected in only a part of one struvite stone by Raman spectra. CONCLUSIONS: Above-mentioned results may indicate that carbonate is only a minor component of urinary stones. Therefore, most of 1420-1435 cm-1 bands on the infrared spectra of struvite stones do not indicate CO3 absorption of carbonate, but NH(4) absorption of magnesium ammonium phosphate.

Chemical compositions of 300 lower urinary tract calculi and associated disorders in the urinary tract.

The stones removed from 273 patients (220 males, 53 females) with bladder stones and 27 patients with urethral stones (males) were analyzed by infrared spectroscopy. Of these stones 50.0% contained magnesium ammonium phosphate (MAP), 39.9% calcium (oxalate and/or phosphate), 9.4% uric acid (urate), and 0.7% cystine. The disorders associated with bladder stones were prostatic hyperplasia and cancer (47.8%), neurogenic bladder (11.8%), urethral stricture (3.6%) and so on in males, and neurogenic bladder (48.1%), after operation of uterus (29.0%), bladder cancer (5.7%) and so on in females. Urinary infections were complications in 59.3% of patients with MAP stones, 41.2% with urate stones and 20.0% with calcium stones. The most often isolated bacteria from the infected urine were of the Proteus species.

[Clinical evaluation of chemohormonal therapy as an initial treatment for stage D2 prostatic cancer--effect of UFT administration combined with hormonal therapy].

We evaluated the usefulness of hormonal therapy combined with UFT as initial treatment in comparison with hormonal therapy alone in 92 patients with Stage D2 prostatic cancer treated at the Department of Urology, Dokkyo University School of Medicine between 1974 and 1993. Twenty-six of these patients were treated with diethylstilbestrol diphosphate (DESP) and castration (hormonal therapy alone group), and 23 patients were treated with UFT, DESP and castration (UFT combined therapy group). The 5-year survival rates calculated with Kaplan-Meier's method in the hormonal therapy alone group and the UFT combined therapy group were 34.6 % and 38.3%, respectively. However, the 3-year survival rates of pathologically poorly differentiated adenocarcinoma in these groups were 30.0% and 50.0%, respectively. Based on these results, it was suggested that UFT administration combined with hormonal therapy is useful for pathologically poorly differentiated adenocarcinoma in Stage D2 prostatic cancer.

[Characteristics of bladder tumors showing positive urinary cytology--respective analysis in differentiated and undifferentiated type].

To study the characters of bladder tumors which showed positive urinary cytologies, the results of urinary cytology of untreated bladder tumor patients in our hospital during 10 years between July 1980 and June 1990 were evaluated according to the degree of tumor differentiation, namely differentiated type which did not contain grade 3, and undifferentiated type which contained grade 3. Concerning the differentiated tumors, positive rate of cytology was 37.3% on the whole. Positive rates of multiple tumors or tumors around internal urethral orifice were significantly high, and those of tumors larger than 3 cm, tumors located on posterior wall, left wall or throughout the entire surface, were higher than the overall positive rates. Repeated examinations of yielded increased rates of positive cytology results. Concerning the undifferentiated tumors, the positive rate of cytology was 90.0% on the whole, was not influenced by tumor sizes or locations, and was consistently observed irrespective of the number of times of cytologic examination.

[Radiopacity of the cystine calculi on KUB].

To study the radiopacity of cystine calculi. We have compared them with oxalate and/or phosphate calculi on plain X-ray films (KUB). Eleven pure cystine calculi from 5 people in 4 families, and 8 oxalate and/or phosphate calculi as controls were obtained from patients by lithotomy or spontaneous discharge in Dokkyo University School of Medicine and affiliated hospitals, since 1978. The radiopacity of cystine calculi was measured by a densitometer PDA-60 (Konika Co.), comparing the density of the calculus with that of the area surrounding the calculus on KUB. All cystine calculi were easily recognized on KUB, and their densities were fairly identical with those of oxalate and/or phosphate calculi.

[Prophylaxis of superficial bladder tumor with the intravesical instillation of bacillus Calmette-Guerin or anti-cancer agents. A retrospective study].

It was retrospectively analyzed whether intravesical instillation of bacillus Calmette-Guerin (BCG) or anti-cancer agents had prophylactic effect or not after removal of superficial bladder tumors. The results over a follow-up period ranging from 6 to 40 months showed 23.8 per cent recurrence in group 1 patients treated with BCG (21 patients), 46.7 per cent recurrence in group 2 treated with anti-cancer agents (45 patients) and 52.3 per cent recurrence in the group 3 (127 patients) which were not received any intravesical drugs. Long-term results among the 3 groups calculated with Kaplan-Meier method demonstrated that the instillation of BCG or of anti-cancer agents was more useful for prophylaxis, compared with the actuarial non-recurrence rates of group 3. The instillation of BCG showed good prophylactic effects especially in recurrent, grade 2 and pTa bladder tumors. The instillation of anti-cancer agents showed to provide prolonged protection from recurrence, but the instillation of BCG did not.

Case of renal medullary fibroma.

An unusual case of renal medullary fibroma accompanied by gross hematuria is reported. This is the eleventh reported case of this disease producing clinical symptoms.

[A bladder cancer with complete remission after arterial infusion of anti-cancer agents (CDDP and THP) and balloon-catheter occlusion of the internal iliac artery: a case report].

The case was a 63-year-old male with the chief complaint of hematuria. A local doctor made the diagnosis of a bladder tumor (egg-sized) on the basis of the results of ultrasonography. CT-scan and cystoscopy. He was thus referred to our Department for treatment. Histopathological study of the biopsied tumor specimen revealed that the tumor was a squamous cell carcinoma. The bilateral internal iliac arteries were occluded for 48 hours, and 100 mg of CDDP and 40 mg of THP were arterially infused. After 7 days, hematuria disappeared, as did the tumor 5 weeks after treatment. No malignancy was noted from histological examination of a biopsy specimen obtained from the cured cancer region using a cystoscope. Since then, there was no recurrence for 12 months. Thus, this approach is thought to be an effective treatment for primary bladder cancer.

[Therapeutic efficacy of fosfomycin and cisplatin alone or in combination on human urogenital cancer by subrenal capsule assay].

Experimental therapies of human urogenital cancer with fosfomycin and cisplatin were performed by subrenal capsule assay. The subrenal capsule assay was applied for 10 cell lines, consisted of 4 renal cell carcinomas, 2 renal pelvic carcinomas, 2 carcinomas of the urinary bladder, one prostatic carcinoma, and one testicular tumor. The efficacy of each drug was evaluated by measuring the tumor growth, and compared the mean tumor volume of treated with that of untreated groups. The growth inhibition rate in fosfomycin group was 60% and in cisplatin group was 80%, whereas that of the combination therapy of both fosfomycin and cisplatin was 50%. This indicates that the combination therapy reduced the antitumor effect. Further, the histological findings also showed a similar pattern in both kidney and tumor tissues between the treated and untreated groups.

Surface topography of deeper cells exposed by ultrasonic wave forces in neoplastic and non-neoplastic epithelium of human urinary bladder.

The topographic features of deeper cells exposed by ultrasonic wave forces were observed in well-differentiated bladder tumors and in the non-neoplastic bladder mucosa of humans by scanning electron microscopy, and the desquamated cells from these tissues were also observed. The surfaces of these deeper cells and of desquamated cells had two types of cellular protrusions: 'ripple-like microridges' and microvillous cellular processes. Slender microvillous cellular processes of various length were observed in the neoplastic tissue in vivo and in the desquamated cells from the tumors, often in a bent or curved condition. In contrast, microvillous cellular processes of the non-neoplastic tissues were relatively short and fewer than those in the bladder tumor cells. In conclusion, microvillous cellular processes of deeper cells in bladder tumors were more pleomorphic than those of deeper cells in the non-neoplastic bladder mucosa, similar to the more pleomorphic microvilli on the luminal surface of superficial cells in the bladder tumors compared to those of superficial cells in the bladder mucosa.

[Immunohistochemical study of tissue polypeptide antigen (TPA) in human urinary bladder tumors].

The immunohistochemical study of tissue polypeptide antigen (TPA) was performed by Avidin-Biotin-Peroxidase complex method (ABC method) in the human bladder tumors. Thirteen bladder tumors (4 cases with transitional cell carcinoma grade 1, 6 cases with grade 2 and 3 cases with grade 3; 7 cases with pTa, 3 cases with pT1 and 3 cases with pT3) were subjected to this study. Prior to the experiment, it was confirmed that the TPA reactivity was not diminished by the tissue fixation with buffered formalin within 72 hours. Bladder tumors of grade 1 and 2 were strongly stained for TPA, whereas bladder tumors of grade 3 appeared to be stained weakly. There were no relationships between TPA stainings and the tumor staging, and between the TPA stainings and the prognosis of the patients. We have concluded that the TPA staining might be a useful method for determination of the bladder tumor grading.

[Clinical application of extracorporeal microexplosive lithotripsy].

A total of 46 cases underwent 66 treatments with extracorporeal microexplosive lithotripsy (EML) for upper urinary tract calculi between March 10, 1987 and May 28, 1987. The efficacy of EML therapy was investigated in all cases over 3 months. The lithotripter of EML made by the Yachiyoda Co. Ltd (SZ-1) was adapted to a microexplosion (10 mg silver azide) as the source of energy for underwater shock wave generation. Fifteen cases (32.6%) had a history of previous open lithotomy of the same upper urinary tract as being treated by EML. Pre-treatments with ureteral catheters and ureteral stents were performed in 4 and 4 cases (8.7% and 8.7%), respectively. The microexplosions were conducted in syncronization with patient exhalation from 100 to 400 times during 1 session, depending upon the size of the stone. The patients felt pressure only on their back at the pulse of explosion and complained occasionally a dull pain, but this pain was mild and tolerable, and no patients required anesthesia. When stone disintegration was judged to be unsatisfactory, that is the stone remained unfragment or the size of the residual stone fragments was greater than 5 mm., an additional session was performed, usually 1 week after the previous session. On the X-ray film obtained three months after EML treatment, 26 cases (57%) were completely free from stone concerments, 17 cases (37%) had stone fragments of equal to or less than 5 mm and 3 cases (6%) had ones of greater than 5 mm. Treatment of EML alone was performed in 44 cases (96%), while 2 cases (4%) required transurethral stone manipulation following EML.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of chemical compositions of multiple or recurrent urinary stones.

The chemical compositions of multiple or recurrent stones, of which the central areas were analyzed by infrared spectroscopy, were compared in each of 110 cases afflicted with upper urinary tract calculi of every type. Nearly all central areas of multiple stones or of initial and recurrent stones in each individual were qualitatively shown to have the same chemical composition except for only 8 cases. Sixty-seven of these one hundred and ten cases had multiple or recurrent stones composed of mixed calcium oxalate-calcium phosphate, and these stones were also used in the measurement of the mixture ratio of phosphate/oxalate from previously formulated infrared spectrum charts. The fairly similar ratios were found in most multiple stones. In the recurrent stones, however, the decreasing ratios were demonstrated in cases with initial stones in the kidney, whereas the increasing ratios in all cases with initial stones in the opposite ureters, and in more than half of the cases with initial stones in the ipsilateral ureters.

[Results of drug sensitivity test of UFT, doxorubicin and cisplatin using human urogenital cancers transplanted subcutaneously into nude mice].

Experimental chemotherapy with UFT, doxorubicin and cisplatin was performed against human urogenital cancers transplanted subcutaneously into nude mice. The tumor take was confirmed in 33 cell lines of human neoplasms which consisted of 10 renal cell carcinomas, 5 renal pelvic carcinomas, 3 ureteral carcinomas, 8 carcinomas of the urinary bladder, 3 prostatic carcinomas and 4 testicular tumors. These three antitumor agents were administered starting at day 14 after subcutaneous transplantation. These agents were administered following doses as used clinical practice for 6 weeks. Effect was evaluated by the inhibition rate calculated by the mean tumor weights of both treated and untreated groups. These results were as follows: Synergic action by combination therapy was observed 8 strains (6%); reduced effect was found 37 strains (28%) and immutable group was detected 87 strains (66%). Our results suggest that there is a necessity to perform drug sensitivity test for combination therapy as well as sensitivity test for single drug.

[Results of the UFT sensitivity test using human urogenital cancers transplanted subcutaneously and under the subrenal capsule of nude mice].

Experimental chemotherapy with UFT was performed against human urogenital cancers, transplanted subcutaneously and under the subrenal capsule (SRC) of nude mice. The tumor take with subcutaneous assay was confirmed in 21 cell lines of human neoplasms, which consisted of 9 renal cell carcinomas, 5 renal pelvic carcinomas, 1 ureteral carcinoma, 3 carcinomas of the urinary bladder, 2 prostatic carcinomas and 1 testicular tumor. On the other hand, the tumor take with subrenal capsule assay was confirmed in 17 of the neoplasm, which consisted of 7 renal cell carcinomas, 4 renal pelvic carcinomas, 4 carcinomas of urinary bladder, 1 prostatic carcinoma and 1 testicular tumor. UFT was administered, starting on Day 14 for subcutaneous transplantation and starting on Day 0 for SRC assay. The dose of UFT was the same as clinical dose for both subcutaneous transplantation and subrenal capsule assays. Treatment with UFT was performed for 6 weeks in subcutaneous transplantation assay and for 4 weeks in subrenal capsule assay. Effect of UFT was evaluated by the inhibition rate (IR) calculated by the mean tumor weights of both treated and untreated groups. Responses to the treatment in subcutaneous transplantation and subrenal capsule assays were judged as effective when the IR were higher than 58% and 20%, respectively. Responses rates of UFT in subcutaneous transplantation and subrenal capsule assays were 43% and 82%, respectively.

[Tegafur and 5-FU concentrations in cancerous and normal tissues in nude mice after oral administration of UFT].

Tegafur and 5-fluorouracil (5-FU) concentrations in blood, tumor, kidney and liver tissues of nude mice implanted with human urogenital carcinoma were determined after oral administration of UFT. The results were as follows: The concentration of tegafur in serum and other tissues rose quickly reading to the peak levels by 15 minutes after administration of UFT, then decreasing gradually. The concentration of 5-FU in serum, liver and kidney showed similar changes, but concentration of tumor tissues were maintained high until 2 hours after administration. These results suggest that coadministration of uracil with tegafur increase the antitumor activity of tegafur.