Michel Carmel

Condyloma acuminatum of bladder

A patient with a condyloma acuminatum of the bladder is presented. This is a rare manifestation of the lesion. The salient features which characterize the lesion are described, and the differential diagnosis is discussed.

Action of clonidine on micturitional reflexes in decerebrate cats

We explored the urodynamic action of clonidine (preferential alpha 2-agonist) and yohimbine (preferential alpha 2-blocker) in decerebrate cats. These animals retain catecholaminergic fibers from the complex of the locus coeruleus to the spinal cord and have synergic and faster micturition cycles than normal cats. Twenty-nine male cats were made decerebrate at intercollicular level under ether anesthesia. Voiding, vesical, urethral and blood pressures, and the EMG of the external sphincter-pelvic floor and leg muscles were studied. Preparations with the urethrovesical junction opened and closed were used. Control activity was characterized by two types of vesical pressure waves: (1) low frequency, high intensity, and (2) high frequency, low intensity. Type-2 preceded Type-1 waves. Clonidine caused: (A) reduction of Type-1 and enhancement of Type-2 Pves waves; (B) diminution of vesical capacity; (C) facilitation of external sphincter relaxation; (D) inhibition of skeletal muscle activity; (E) systemic hypotension and bradycardia. Yohimbine inhibited clonidines actions. When injected alone, it inhibited vesical and increased sphincteric activities. It also produced systemic hypertension and enhanced crisis of autonomic dysreflexia. The overall effect of clonidine on urodynamics in acute decerebrate cats was to bring about an active, small (normotonic) bladder with urinary frequencies. We suggest that clonidine: (1) inhibited Type-1 waves by inhibiting cellular activity in the locus coeruleus. As a result, the vesico-vesical contraction long loop reflex was abolished; (2) facilitated Type-2 waves by inhibiting inhibitory interneurons in the sacral parasympathetic center. As a result, the vesicovesical contraction short loop reflex was facilitated.

Hindgut dysgenesis as a cause of constipation with delayed colonic transit.

In a patient complaining of constipation since birth, delayed transit time in the ascending colon was related to a congenital malformation of the hindgut, different from Hirschsprungs disease. This was associated with absence of the left lobe of the liver. There was no propagating electrical muscular activity in the distal bowel.

Assisted Erection Follow-up with Couples

Erection obtained with a vacuum pump can be a solution for the impotent man. In this study it was proposed to and discussed with couples, eleven of whom chose it as treatment. The mean age of the men was 54 years and 8 months. The estimated etiology of their erectile disorder was: biogenic, 4, mixed, 7. A 25-item questionnaire was administered to each couple. Results show that the device was a good solution and improved the sex life of both partners. They manifested a fair degree of satisfaction with its use. The presence and the participation of the female partner should be considered in therapeutic recommendations for erectile disorders.

Studies on the characterization of rat prostate androgen receptors

In the presence of sodium molybdate and protease inhibitors, two forms of androgen-receptor complexes were observed which sedimented in the areas of 8–9S and 5–7S by SDG centrifugation. The intermediary 5–7S form was better seen when complexes were incubated at low KCI concentrations. The sedimentation coefficient of this form fluctuated between 5 and 7S depending on the KCI concentration. At high ionic strength (0.6M KCl) in all media, one form only was observed having a sedimentation coefficient value of 4.3S. By gel exclusion chromatography, we also observed two specific entities at 75A and 68A; in the presence of 0.6M KCl, however, two entities were found at 68Å and 43Å. The constant presence of protease inhibitors in all buffers was necessary to separate the intermediary 68A form. We calculated molecular weights of about 270 kDa, 190 kDa, and 80 kDa respectively for these three forms. [3H]R1881-receptor complexes bound to DEAE-cellulose and were eluted in the absence of glycerol at O.1M and 0.2M KCl. Material found at 0.1M KCl sedimented in the areas of 5–7S and 8–9S in nearly equal proportion, and that found at 0.2M KCI sedimented in the 8-9S area only. When the cytosol was chromatographed at a fast flow rate (4ml/min), untransformed 8–9S receptors did not bind to phosphocellulose, but transformed complexes were retained, could be eluted with 0.4M KCl and sedimented in the 4S area on KCI free SDG centrifugation. When the excluded untransformed 8–9S complexes were re-chromatographed at a slow flow rate (1ml/min), they were retained on phosphocellulose, and could be eluted with 0.3M KCI. Complexes of this latter fraction still sedimented in the 8–9S area on KCl free SDG centrifugation. The first fast flow rate chromatography was thus necessary to eliminate destabilizing components, presumably proteases. In conclusion, we were able to demonstrate and to characterize an intermediary 5-7S (6.6S after desalting) form of androgen receptors in rat ventral prostate. Also, using specific experimental conditions, we were able to conserve the 8–9S form during a series of manipulations including phosphocellulose chromatography. The presence of a putative ‘ζ’ subunit which may participate in the formation of the 8-9S form is postulated.

Characteristics of the rat prostate androgen receptors analyzed by sucrose density gradient and high-performance liquid chromatofocusing.

Rat prostate cytosolic androgen-receptor complexes were analyzed by sucrose density gradient (SDG) centrifugation and by high-performance liquid chromatofocusing (HPCF). Without protecting agents, these complexes were resolved by HPCF at basic (8.25-7.1), intermediary (7.0-5.0) and acidic (4.6-4.2) pH. Sodium molybdate stabilized labeled complexes which migrated in the 8-9S and 3.5-6S areas on SDG. These were further stabilized by the presence of sodium molybdate and four protease inhibitors: complexes then sedimented mainly in the 8-9S area with a shoulder at 6-7S. Forms eluting at acidic pH on HPCF were favored by the presence of sodium molybdate and further enhanced by the addition of inhibitors, to the detriment of basic ones. Furthermore, when chromatographed on phosphocellulose (P-c), unretained complexes sedimented as a symmetrical peak on SDG centrifugation in the 8-9S area, but were eluted from HPCF columns as two entities at pH 4.1 and 4.6. The P-c retained complexes subsequently detached by 0.6 M KCl, were resolved into three entities by HPCF with a major component at pH 8.2, which sedimented in the 4S areas. These results demonstrate that the gradual decrease in the negative net charge of androgen receptor correlates with the gradual reduction in mass of the androgen-receptor complex. Moreover, this can be interpreted as further evidence for a heterogeneity of androgen receptor population in rat prostate, suggesting the involvement of a multistep mechanism preceding the induction of specific gene transcription by the hormone.

Application of high-performance liquid chromatofocusing to the study of prostatic androgen receptors: effect of stabilizing agents on the heterogeneity of receptor structure

Cytosolic androgen receptors from normal rat prostate were analyzed by high-performance liquid chromatofocusing. Two ion-exchange columns, AX-300 and AX-500, and two equilibration systems, Tris-HCl and imidazole-HCl, were used. pH gradients ranged between 8.3 and 3.5 for Tris-HCl and from 7.7 to 3.5 for imidazole-HCl. In the absence of sodium molybdate and inhibitors of proteolytic enzyme, six specific radioactive fractions (pH: 7.9, 7.7, 7.0, 5.1, 4.7 and 4.4) were eluted from AX-300 equilibrated with Tris-HCl in a ratio of 28:20:52 for acidic, intermediary and basic forms, respectively; similar results were obtained with AX-500 although this column was less effective in resolving basic forms of the receptor. The buffering capacity of imidazole-HCl was lower than that of Tris-HCl, resulting in a steeper elution pH profile. The resolution between acidic and basic forms was thus diminished and only four specific radioactive fractions at pH 7.2, 7.1, 6.5 and 3.6, were observed on AX-500 in a ratio of 23:10:67 for acidic, intermediary and basic forms. In the presence of sodium molybdate, two acidic fractions were found with Tris-HCl at pH 4.3 and 4.7 (47%) on AX-300, whereas the radioactivity of fractions at pH 7.0 and 5.1 (32%) was considerably lowered and intermediary forms remained unchanged (21%). With imidazole-HCl on AX-500, the peak at pH 7.2 disappeared and the acidic form shifted from pH 3.6 to 4.3. In the presence of inhibitors of proteolytic enzyme and sodium molybdate, specifically bound radioactivity was found mostly in a broad acidic fraction (75%) at pH 4.5 on columns equilibrated with Tris-HCl; radioactivity at pH 7.6 disappeared completely but a small amount (15%) remained at pH 7.9. In imidazole-HCl, a main radioactive fraction was eluted at pH 7.1 and two other fractions were collected at pH 6.8 and 4.3 respectively. In conclusion, multiple forms of the rat prostate androgen receptor were evinced by high-performance liquid chromatofocusing. Tris-HCl proved to be a more efficient equilibration system than imidazole-HCl for the resolution of rat prostate cytosolic binding proteins. Under the experimental conditions used, sodium molybdate and inhibitors of proteolytic enzyme greatly favored the acidic form to the detriment of the intermediary and basic entities.

Optimization of the 2014 Gleason grade grouping in a Canadian cohort of patients with localized prostate cancer

To evaluate the five‐tier Gleason grade group (GG) scoring of prostate cancers adopted by the International Society of Urology Pathology (ISUP) in 2014, and to propose modifications to optimize its performance.

Bilateral Renal Masses with Different Histopathology Subtypes Treated by Laparoscopic Right Partial Nephrectomy and Bilateral Cryoablation- Results at 5 Years Follow-Up

We present the case of a 54 year old man with a synchronous mass on each kidney with different renal cell carcinoma (RCC) subtypes and a normal renal function. He categorically refused to undergo radical nephrectomy and open partial nephrectomies. He underwent a laparoscopic right partial nephrectomy and then percutaneous CTguided bilateral cryoablation. A second percutaneous CT-guided course of cryoablation on the right mass was performed at 6 months post cryoablation for recurrence. Both chest and abdomen CT-Scan at 60 months follow up did not reveal any local recurrence or distant metastasis. Although cryoablation is a feasible treatment option for RCC, the authors do not recommend it as a first line therapy in an otherwise healthy patient with normal renal function.