Tsutomu Ohhori

Two Circulatory Routes Within the Human Corpus Cavernosum Penis: A Scanning Electron Microscopic Study of Corrosion Casts

The microvascular architecture of the human corpus cavernosum penis was studied by scanning electron microscopy of vascular corrosion casts. The corpus cavernosum was supplied by the penile deep artery. It gave off branches to become either arteries distributed within the corpus cavernosum or those directly supplying the corpus spongiosum urethrae. The former arteries further divided into small arteries which fell into two categories: 1) arteries breaking up into capillaries, and 2) arteries draining directly into the cavernous sinuses. The capillaries were collected into venular networks just beneath the tunica albuginea (the subalbugineal venular plexus), while the cavernous sinuses were collected into venules at the periphery of the corpus cavernosum. These postcavernous venules also received venules from the subalbugineal venular plexus, and left the corpus cavernosum. Thus, two circulatory routes are evident within the corpus cavernosum. These findings suggested that the penile erectile cycle is controlled by hemodynamic changes between these two routes within the corpus cavernosum.

Significance of Staging Pelvic Lymphadenectomy for Prostatic Cancer

Staging pelvic lymphadenectomy in 31 cases in stages A2-C prostatic cancer was performed. In 15 of the cases (48%) lymph node invasion was found. Metastatic tendency strengthened with an increase in Gleason scores, although no metastases were found in 38% of the cases with Gleason scores of 8-10. Percutaneous fine-needle aspiration biopsy guided by lymphography was conducted in 14 cases and 17% were false-negative. Lymph node metastases were found in the common iliac lymph nodes in 47%, external iliac lymph nodes in 67% and internal iliac obturator lymph nodes in 100%. Prolonged lymph drainage in 4 cases (13%) and wound infection in 2 cases (3%) were found as postoperative complications, but they were all treated conservatively. So it was concluded that pelvic lymphadenectomy was a reasonable adjunct to total prostatectomy since it provided an accurate assessment of the anatomic distribution of disease, which could be of help in selecting treatment. Dissection of the lymph nodes of the internal iliac obturator was considered quite sufficient to establish the presence of any lymph node metastases.

Quantitative analysis of outflow pathway of corpora cavernosa by pressure flow technique.

Using a pressure flow technique, quantitative analysis of the physiological characteristics of the outflow pathway of the corpus cavernosum was carried out in 19 male dogs weighing 7.5 to 23.0 kg. Pressure flow curves were made on dogs whose pelvic nerve was stimulated electrically and on dogs left unstimulated. When a cyclical change in saline perfusion rate was applied without nerve stimulation, the variable of the intracorporeal pressure showed a large hysteretic loop, indicating that the resistance of the outflow canals to flow was altered by the distension of the sinusoidal space. In dogs whose pelvic nerve was stimulated, the pressure flow curves shifted to the left side in comparison with the outward phase of the pressure flow curve of animals without pelvic nerve stimulation, and this curve piled on the returning phase. No hysteretic relation was observed between the outward and returning phase of the pressure flow curve with pelvic nerve stimulation, but in the detailed analysis, in which the % flow rate was used instead of actual flow rate of saline perfusion, a small hysteretic loop based on the difference of the elasticity of the outlet canals was found. The distension of the corpora cavernosa and the pelvic nerve electrostimulation probably act as the triggers of the same occlusive mechanism in the outflow pathway. The percentage decrease in the blood flow in the outflow canal of the corpus cavernosum induced by the distension of the sinusoidal space or by the pelvic nerve electrostimulation was 69.6 +/- 14.4% (mean +/- SD).

Human Penile Hemodynamics Studied by a Polarographic Method

Observations of the tissue oxygen tension alteration were made using an open tip type oxygen electrode polarographic method as an index of blood flow change in the penile skin, corpus cavernosum and thigh skin of 16 males aged 20-26 years (average age: 20.5 years). In another five males aged 18-21 (average age: 19.8 years) the relationship between corpus cavernosum tissue oxygen tension alteration and penile circumference change in the erection process was observed. This relation was obtained in the penile circulation model, and penile hemodynamics were ascertained. In the flaccid penis the corpus cavernosum contains low-oxygen blood and there is a blockade at the vascular tree in the corpus cavernosum. In the tumescence phase the blood flow of the corpus cavernosum increased suddenly by the relief of cavernosum vascular blockade. During the penile tumescence phase the increased inflow and outflow persisted in corpus cavernosum, and in penile skin the blood also increased initially, but gradually decreased as penile circumference increased. After erection was attained it is thought that resistance to inflow occurred by outflow pathway contraction. In the detumescence phase, a decrease of inflow and a concomitant increase of outflow occurred and the reopening of outflow is thought to be necessary for prompt penile detumescence.

Prostatic epithelial polyp of the prostatic urethra.

Ten cases of prostatic epithelial polyps of the prostatic urethra are reported. The ages of the patients were from 27 to 69 years, with a mean of 44 years. The most common clinical signs were gross hematuria, microhematuria, hematospermia, and dysuria. All specimens, obtained by transurethral resection, had a papillary or polypoid configuration. The tissue had a glandular structure that resembled that of the prostate. Prostate-specific antigen and prostatic acid phosphatase were found in the epithelial cells of the polyps by indirect immunoperoxidase staining. The polyps seemed to be hyperplasia of prostate-specific antigen and prostatic acid phosphatase-positive epithelial cells of the prostatic gland or duct, especially that of the latter.

Combined effects of intraperitoneal administration of recombinant interleukin-2 and streptococcal preparation OK-432 in murine tumors.

The combined effects of rIL-2 and OK-432 were investigated against a Meth-A tumor, a syngeneic tumor of inbred BALB/c mice. An analysis of the effector cells was also performed. The treatment resulted in an inhibition in vivo of tumor growth and increased survival of the Meth-A tumor-bearing mice. Splenic cells obtained from Meth-A inoculated mice which received combination therapy were not only NK-sensitive YAC-1 and LAK-sensitive EL-4 cells, but also NK-resistant Meth-A cells, as shown in a 4-h 51Cr-release assay. Syngeneic killer cell activity against Meth-A cells was abolished almost completely with anti-Thy 1.2 treatment and about 70% of the activity was abolished with anti-asialo GM1 treatment in a complement-dependent cytotoxic assay. It was not changed by the removal of macrophages and B cells from the splenic cells. Mice which survived for 60 days after the start of therapy rejected Meth-A inoculation when rechallenged, suggesting the establishment of a specific immunity. Combination therapy appeared to be beneficial against Meth-A cells and T-cells appeared to play a determining role in the treated Meth-A bearing mice. It was suggested that more than two populations of killer cells exist in the spleen treated with the combined therapy and they may have the same characteristics as activated T and NK cells with or without specific killer T-cells.

Investigation of Blood Group Antigens and Carcinoembryonic Antigen in Urinary Bladder Carcinoma

Blood group antigens and carcinoembryonic antigen (CEA) were sought in the tissues of 37 bladder tumor cases using enzyme antibody method. A correlation (p less than 0.01) was found between the extinction of ABO (H) and progressive malignant states of the tumor or invasion stage. Significant correlation (p less than 0.05) was observed between the presence of CEA and the invasion stage. The state of the T antigen, however, did not reflect the malignancy grade or invasion stage. The states of ABO (H) and CEA significantly reflected (p less than 0.05) the prognosis, as did the malignancy grade and invasion stage, while the state of the T antigen did not correlate with the prognosis. Although there was a correlation (p less than 0.01) between the extinction of ABO (H) blood group antigens and the presence of CEA, the state of T antigen did not significantly correlate with ABO (H) antigen or CEA. From what has been mentioned, the search for intratissue ABO (H) antigens and CEA is important and will provide a useful auxiliary means in diagnosing biopsy specimens.

Recombinant interleukin-2-induced regression of pulmonary metastasis of renal cell carcinoma.

A patient having renal cell carcinoma with multiple pulmonary metastasis was treated with recombinant interleukin-2. Pulmonary metastatic nodes were markedly diminished. The response was maintained for 4 months. At Autopsy, many fibrotic areas in which metastatic carcinoma was thought to have previously existed and then healed were observed in the bilateral pulmonary lobes, although a few microscopically tiny metastatic lesions still remained.

Antigenic relationship between streptococcal preparation OK-432 and tumors and its effect on immunotherapy with OK-432 in patients with superficial bladder tumor.

The cross-antigenicity between streptococcus, Su strain (OK-432), and rat bladder cancer BC-47 was studied by the immunocytochemistry. Both anti-Su (OK-432) and anti-BC-47 reacted with both homo- and heterogenous antigens. The specificity of the PAP reactions using these sera was confirmed by absorption study of the first antibodies. But, OK-432 did not share with normal rat tissues. Furthermore, the presence of common antigens between OK-432 and animal tumors where OK-432 was effective was indicated by the PAP studies, but OK-432 did not share with tumors where OK-432 was ineffective. By the PAP studies using antigroup A streptococcus-specific C-polysaccharide and antigroup-specific sera, it was suggested that the determinant of the cross-antigenicity was group A-specific C-polysaccharide. The common antigens between OK-432 and human urogenital cancers were also identified by the PAP study. Then, local immunotherapy with OK-432 was carried out in 38 patients with superficial bladder tumor and the tumors were eliminated in 23.7%. In 77.8% of the complete response and in 10.3% of the no change, the tumor tissues demonstrated antigens common between OK-432 and tissues. From these results, it was concluded that common antigens which OK-432 shared with tumors could favorably augment host defense against human bladder tumors, the same as animal tumors.