Munekado Kojima

Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: A preliminary report

The aim of the present study was to evaluate the usefulness of ultrasonic estimation of bladder weight as a measure of bladder hypertrophy using transabdominal ultrasonography in men with infravesical obstruction. Ultrasonically estimated bladder weight (UEBW) was calculated from the thickness of the bladder wall measured ultrasonically and the intravesical volume at the ultrasonic measurement, assuming a spheric bladder. There was a statistically significant correlation (r = 0.970, P <0.001) between the actual bladder weight of cadaver bladders and the UEBW. The UEBW did not change with bladder filling. The UEBW in the obstructed group (group O, 49.7 +/- 19.5 g, mean +/- SD) was significantly greater than that in the normal control group (group NC, 25.6 +/- 5.7 g; P <0.001) or the nonobstructed group (group NO, 28.4 +/- 4.2 g; P <0.001). The greatest UEBW was 34.8 g in group NC and 35.2 g in group NO, whereas 94% (45 of 48) of group O had a UEBW greater than 35.0 g. In all 5 patients with benign prostatic hyperplasia (BPH), the increased UEBW decreased to a normal control level at 3 months after treatment of BPH. This new noninvasive method may be useful in investigation of bladder hypertrophy.

Noninvasive Quantitative Estimation of Infravesical Obstruction Using Ultrasonic Measurement of Bladder Weight

PURPOSE Ultrasound estimated bladder weight was compared to pressure-flow studies to test the ability of ultrasound estimated bladder weight to predict infravesical obstruction. MATERIALS AND METHODS A total of 65 men with urinary symptoms underwent ultrasonic measurement of bladder weight and pressure-flow studies. Assuming the bladder is a sphere, ultrasound estimated bladder weight was calculated from bladder wall thickness measured ultrasonically and intravesical volume. RESULTS Ultrasound estimated bladder weight correlated significantly (p < 0.0001) with the Abrams-Griffiths number, urethral resistance factor and the Schäfer grade of obstruction. A cutoff value of 35 gm. for ultrasound estimated bladder weight revealed a diagnostic accuracy of 86.2% (56 of 65 cases) for infravesical obstruction with 12.1 (4 of 33) and 15.6% (5 of 32) false-positive and false-negative rates, respectively. CONCLUSIONS Ultrasound estimated bladder weight can be measured noninvasively at the bedside and it is promising as a reliable predictor of infravesical obstruction.

Correlation of histological inflammation in needle biopsy specimens with serum prostate- specific antigen levels in men with negative biopsy for prostate cancer

OBJECTIVES To reveal the possible contribution of histological inflammation within the prostate to the abnormal elevation of serum prostate-specific antigen (PSA) levels in patients with needle biopsy negative for prostate cancer. METHODS We reviewed negative needle biopsy specimens obtained in 93 patients. The degree of acute and chronic inflammation as evaluated histologically was compared with serum PSA levels in conjunction with age and prostate volume. RESULTS Both age (P <0.01) and prostate volume (P <0.0001) correlated significantly with serum PSA levels and were significantly greater in patients with abnormal serum PSA levels (greater than 4.0 ng/mL) than in those with normal serum PSA levels (4.0 ng/mL or less) (P <0.01). The presence of histological inflammation within the prostate also correlated significantly with serum PSA levels. Multiple regression analysis demonstrated prostate volume to be the only independent determinant of serum PSA levels (P <0.01). In patients with a prostate volume larger than 25 mL, only prostate volume correlated significantly with serum PSA levels (P <0. 05). On the other hand, the degree of acute inflammation as represented by polymorphonuclear leukocyte infiltration was the only parameter correlating significantly with serum PSA levels (P <0.05) in patients with a prostate volume smaller than 25 mL. CONCLUSIONS Histologically defined acute inflammation within the prostate is a significant contributor to elevated serum PSA levels, especially in patients with small prostates. In the assessment of needle biopsy results negative for prostate cancer, it might be helpful to evaluate the degree of histological inflammation, especially in terms of the necessity of subsequent repeated biopsies.

Reversible Change of Bladder Hypertrophy Due to Benign Prostatic Hyperplasia After Surgical Relief of Obstruction

PURPOSE Ultrasound estimated bladder weight was compared before and after surgery for benign prostatic hyperplasia (BPH) to reveal a possible reversible change in bladder hypertrophy. MATERIALS AND METHODS Ultrasound estimated bladder weight was measured before and after subcapsular (17) or transurethral (16) prostatectomy in 33 male patients with BPH. Sequential changes in the American Urological Association symptom score and urinary flow rate were also examined. RESULTS Along with a significant improvement in the American Urological Association symptom scores and maximum flow rate, ultrasound estimated bladder weight decreased from 52.9 +/- 22.6 to 31.6 +/- 15.8 gm. in 12 weeks after treatment. In all but 4 patients (29 of 33, or 87.9%) ultrasound estimated bladder weight decreased to less than 35.0 gm. in 12 weeks after treatment. Interestingly, in all patients with an initial ultrasound estimated bladder weight of greater than 80 gm. the bladder weight still remained at an abnormally high level 12 weeks after treatment. CONCLUSIONS Bladder hypertrophy was completely reversible after the surgical treatment of the obstruction in the majority of patients with BPH. The measurement of ultrasound estimated bladder weight was of value in monitoring therapeutic effects in BPH patients. An extraordinarily high ultrasound estimated bladder weight of 80 gm. or more might suggest degenerative and irreversible pathological changes in the bladder detrusor.

Immunohistochemical study on the localization of serotonin fibers and terminals in the spinal cord of the monkey (Macaca fuscata)

SummaryA modified procedure of PAP-immunohistochemistry with the use of a rabbit antiserum against serotonin was applied to investigate the pattern of serotonin-containing nerve fibers in the spinal cord of the monkey, Macaca fuscata.The majority of descending serotonin fibers in the white matter is located immediately below the pia mater in the ventrolateral funiculi. Lamina I and the outer zone of lamina II are supplied with numerous serotonin fibers. In the intermediate gray, two prominent bundles composed of longitudinal fibers, i.e., lateral and medial longitudinal serotonin bundles, were recognized at the lateral column and in the vicinity of the central canal, respectively. The motoneurons of the anterior horn are encompassed by fine networks of serotonin fibers and terminals.The results obtained from studies with the monkey spinal cord closely resemble those characteristic of the dog spinal cord as presented in a previous paper, except for portions of the lumbar level. In segments L3–L4, intercalated cell groups between the medial and lateral motor nuclei receive particularly rich inputs of serotonin fibers in the same manner as the neurons of the nucleus intermediolateralis. This peculiar finding may suggest the presence of a specialized nucleus in the anterior column of the simian and also human spinal cord.

Serotonergic innervation on the motoneurons in the mammalian brainstem

SummaryA comparative study of serotonergic innervation on motoneurons in the brainstem of various mammals (mouse, rat, guinea pig, dog, cat and monkey) was carried out using a sensitive immunohistochemical method. Except for the extraocular muscle nuclei, the motor nuclei of the cranial nerves received rich inputs from serotonin neurons, in all species examined — rodent, carnivore and primate. The motoneurons of the monkey were innervated by varicose serotonin fibers, in a manner different from that of other species, i.e. their cell bodies and proximal dendrites were tightly encircled by a large number of serotonin-containing varicose fibers. At the ultrastructural level, a predominant population of axosomatic contacts was confirmed in the cranial motor nuclei of the monkey, particularly in the nucleus ambiguus.

Immunohistochemical study on the distribution of serotonin fibers in the spinal cord of the dog.

SummaryDistribution of serotonin fibers in the spinal cord of the dog was investigated by means of a modified PAP method; a rabbit anti-serotonin serum prepared in the laboratory of the authors was used in this study. Serotonin fibers were revealed as PAP-positive dark-brown elements displaying dot-like varicosities (0.5–2.0 μm in diameter). In the spinal cord of the dog, the distribution of serotonin fibers is extensive. These fibers occur more densely in more caudal segments and are most prominent at the sacrococcygeal level. From the level of the cervical spinal cord to the upper lumbar region, the descending serotonin fibers are located immediately under the pia mater in the ventrolateral portion of the lateral funiculus. In more caudal segments, serotonin fibers are dispersed throughout the ventral and lateral funiculi. These longitudinal en passage-fibers send numerous transverse collaterals to the gray matter. Serotonin fibers are distributed abundantly in the laminae I and III of the posterior column, while only a few fibers are found in the lamina II (substantia gelatinosa). In the intermediate zone, two descending serotonin pathways, i.e., lateral and medial longitudinal bundles, are observed to coincide topographically with the nucleus intermediolateralis at C8(T1)-L3(L4) and the nucleus intermediomedialis at C1-Co respectively. The former is particularly prominent and communicates with the contralateral bundle via commissural bundles at intervals of 300–500 μm. The large motoneurons in the anterior column, especially those in the nucleus myorabdoticus lateralis within the cervical and lumbar enlargements, are closely surrounded by fine networks of serotonin fibers and terminals.

Sexual differences in the topographical distribution of serotonergic fibers in the anterior column of rat lumbar spinal cord

SummarySexual dimorphism in the topographical organization of immunoreactive serotonergic fibers has been shown for the first time in the anterior column of the rat lumbar cord. A characteristic preferential arrangement of serotonergic fibers on the small cell column composed of anterior horn motoneurons, which have been proved to send their axons to the cremaster muscle, was demonstrated at the lumbar segments (L1–L2) of male rats, using the immunoperoxidase technique with antiserum against serotonin. A similar finding was also observed in female rats, but was less prominent than in males. Comparative analysis of the cell numbers and the size of neuronal somata of the aforementioned nucleus, done using retrograde transport of fluorescent dye (DAPI) via axonal fibers coursing down the genitofemoral nerve to the cremaster muscle, gave significantly larger values in males.The sexual difference in the serotonergic innervation pattern was, in consequence, surmised to be caused by the cytoarchitectonic contrast ascertained in the lumbar anterior column. Furthermore, there may be a striated muscle endowed with some active functions homologous to those of the male cremaster muscle in the female rat.

Preliminary results of power Doppler imaging in benign prostatic hyperplasia

Power Doppler imaging was performed in 77 patients with lower urinary tract symptoms to characterize Doppler blood-flow signals in benign prostatic hyperplasia (BPH). Pulsatile blood flows were detected in all patients, demonstrating a significant increase of the resistive index (RI) in BPH cases (n = 40, 0.72 +/- 0.05, p < 0.0001), compared to those with a healthy prostate (n = 37, 0.64 +/- 0.04). Of 40 patients with BPH, 28 (70%) had an RI of 0.70 or higher; all but 1 patient with a healthy prostate (1 of 37, 3%) had an RI lower than 0.70 (p < 0.0001). In all 10 patients with BPH, the elevated RI decreased significantly to a normal control level after surgical treatment (0.72 +/- 0.02 vs. 0.64 +/- 0.05, p < 0.001). In conclusion, Doppler RI might be useful as a new urodynamic parameter in BPH.

Transrectal power Doppler imaging in the detection of prostate cancer.

Objectives To evaluate the clinical utility of transrectal power Doppler imaging (PDI) of the prostate for detecting prostate cancer in patients with abnormally high serum levels of prostate specific antigen (PSA).