Martin G. Mcloughlin

Characterization of the Binding of a Potent Synthetic Androgen, Methyltrienolone, to Human Tissues

The potent synthetic androgen methytrienolone (R 1881), which does not bind to serum proteins, was utilized to characterize binding to receptors in human androgen responsive tissues. Cytosol extracts prepared from hypertrophic prostates (BPH) were utilized as the source of receptor for the initial studies. High affinity binding was detected in the cytosol of 29 of 30 samples of BPH (average number of binding sites, 45.8+/-4.7 fmol/mg of protein; dissociation constant, 0.9+/-0.2 nM). This binding had the characteristics of a receptor: heat lability, precipitability by 0-33% ammonium sulfate and by protamine sulfate, and 8S sedimentation coefficient. High affinity binding was also detected in cytosol prepared from seminal vesicle, epididymis, and genital skin but not in non-genital skin or muscle. However, similar binding was demonstrated in the cytosol of human uterus. The steroid specificities of binding to the cytosol of male tissues of accessory reproduction and of uterus were similar in that progestational agents were more effective competitors than natural androgens. Binding specificities in cytosol prepared from genital skin were distinctly different and were similar to those of ventral prostate from the castrated rat in that dihydrotestosterone was much more potent than progestins in competition. Thus binding of R 1881 to the cytosol of prostate, epididymis, and seminal vesicle has some characteristics of binding to a progesterone receptor. When the nuclear extract from BPH was analyzed, high affinity binding was demonstrated that conformed to the specificities of binding to an androgen receptor. Here dihydrotestosterone was a more potent competitor than progestational agents. Similar patterns of binding were detected in the crude nuclear extracts from seminal vesicle, epididymis, and genital skin but not in uterus, muscle, or non-genital skin. We conclude that the androgen receptor is not demonstrable in the cytosol of prostate, epididymis, or seminal vesicle of non-castrated men but can be measured in the cytosol of genital skin and the nuclear extracts of androgen responsive tissues. Because steroid hormones exert their major influence within the nucleus of target tissues, the measurement of nuclear receptor may provide valuable insight into the regulation of growth of target tissues.

The measurement of androgen receptors in human prostatic tissue utilizing sucrose density centrifugation and a protamine precipitation assay

Methods have been established for the measurement of androgen receptors in the cytosol and crude nuclear extract of human prostatic tissue using sucrose density gradient centrifugation and a protamine precipitation assay. These studies have demonstrated the presence of a high affinity, heat labile protein that binds preferentially to dihydrotestosterone and that is present only in androgen target tissues. In studies of prostatic tissue from 15 patients sucrose density gradient centrifugation appeared more sensitive than the protamine precipitation assay in the identification of androgen receptors. These findings appear promising and suggest that in the near future a reliable assay may be available for the measurement of androgen receptors in prostatic carcinoma.

Sonography in the diagnosis of retroperitoneal fibrosis.

The ultrasonic appearance of retroperitoneal fibrosis is characteristic: a smooth-bordered and relatively echo-free mass anterior to the sacral promontory. Sonography can be used to confirm the diagnosis, follow response to therapy and detect hydronephrotic changes in the kidneys.

The Surgical Approach to Urological Complications in Renal Allotransplant Recipients

Urinary extravasation or ureteral obstruction occurred in 22 patients who received 30 transplants in a series of 290 renal transplants. This incidence represent 10.3 per cent of the entire transplant experience at The Johns Hopkins Hospital and Baltimore City Hospitals from 1968 to the present time. Ureteroneocystostomy was used as the primary form of urinary tract reconstruction in all but 1 patient who had urinary complications. These 22 patients received 30 renal transplants: 6 from living related donors and 24 from cadaver sources. There were 15 instances of urinary extravasation and 14 instances of obstruction. All but 2 fistulas were diagnosed within 30 days of the original transplant. Obstruction occurred later, with 4 cases of ureterovesical obstruction being diagnosed 3 to 5 years after the transplant procedure. The ureterovesical junction or bladder was the site of complication in 17 of the 29 instances. Surgical management in these cases was highly individualized, with successful outcomes more commonly attained in those cases characterized by obstruction. Ureteral stents were used in all but 1 secondary procedure involving the ureter and these stents were not associated with an increased incidence of urinary tract infection. Death directly related to the urological complications occurred in 2 cases, 5 patients underwent transplant nephrectomy and 2 patients died of rejection and infection more than 6 months after the urinary fistulas were successfully managed. From the original series, there are 15 of the 22 patients who have stable renal function after secondary or tertiary urological procedures on the transplanted kidney. Four patients underwent surgical correction of hydronephrosis associated with infection or diminishing renal function more than 3 years after the transplantation and 3 of these had good results.

Long Blind-Ending Ureteral Duplications

Long blind-ending ureteral duplications can be symptomatic and require surgical intervention. Three patients with long blind-ending ureteral duplications had prominent reflux and required either resection of the blind ureter and ureteral reimplantation or nephroureterectomy.

Telecobalt therapy for prostatic cancer: rationale, results, and future considerations

External supervoltage radiation is now an accepted form of treatment for adenocarcinoma of the prostate but the tumor response cannot be predicted. We hope in the future that accurate clinical staging coupled with a biological staging of the tumor cells with catalase activity will enable us to predict this response. Ionizing radiations act by producing active radicals, hence the rationale of studying the tissue catalase activity in conjunction with the histological grading may provide a more accurate index of patients who would gain the most benefit from radiotherapy. (auth)

Clamp for microsurgical vasovasostomy.

AbstractThe clamp described herein offers a good means of approximation for microsurgical vasectomy reversal.

Renal aneurysmectomy in the ex vivo setting.

The use of ex vivo dissection and reconstruction as definitive surgical management in 3 cases of renal artery aneurysms is presented. The indications, rationale for therapy and review of technique are discussed.

Acute Pyelonephritis in A Transplant Patient with an Ileal Loop Mimicking Rejection

The clinical picture of an enlargement in kidney size, a decrease in renal function and an increase in temperature in a patient with a transplanted kidney into an ileal loop presents a problem in differential diagnosis among rejection, acute tubular necrosis and acute pyelonephritis.

Unusual Cause of Anuria in a Transplant Patient

Abstract A case is described of a pregnant renal allograft recipient, near full-term, who presented with a sudden onset of anuria accompanied by azotemia.