RESUMEN
PURPOSE: GP51 is a urinary glycoprotein with a molecular weight of 51 kDa. This glycoprotein is produced and secreted by the transitional epithelium of the genitourinary tract, and has been isolated from human urine. Studies have demonstrated that GP51 levels are decreased in bladder biopsies of patients with interstitial cystitis. We evaluated urinary GP51 in a noninvasive manner as a clinical marker of interstitial cystitis. MATERIALS AND METHODS: Urinary GP51 levels were measured using antigen inhibition enzyme-linked immunosorbent assay. In blinded fashion we analyzed for quantitative differences 24-hour urine samples of 36 patients with interstitial cystitis and 23 normal controls who were age matched within 5 years (mean age 47.3). We also evaluated GP51 in random urine specimens of 17 normal controls, 14 patients with interstitial cystitis and 11 subjects who had undergone cystectomy to determine whether urinary GP51 is mainly produced by the bladder, which is the site of interstitial cystitis. To ascertain the specificity of urinary GP51 to interstitial cystitis urine samples of 34 patients with other urological diseases were measured and compared with findings in the samples of 15 with interstitial cystitis. RESULTS: Low GP51 levels appeared to be unique to the interstitial cystitis state compared to normal (p = 0.008). GP51 in patients with interstitial cystitis and in those who underwent cystectomy was lower (p < 0.001) than in normal controls. These findings suggest that the major source of urinary GP51 is the bladder. Also, we observed lower GP51 levels in interstitial cystitis than in other urinary tract diseases (p < 0.0001). CONCLUSIONS: Our study substantiates the possibility of using GP51 as a clinical marker for diagnosing interstitial cystitis by a noninvasive urinary assay.
Asunto(s)
Cistitis Intersticial/orina , Glicoproteínas/orina , Biomarcadores/orina , Humanos , Persona de Mediana EdadRESUMEN
A dartos-based transverse skin flap for ventral penile skin coverage is used as an adjunct to hypospadias surgery. The technique is simple and reliable. After completing the primary repair of the penis, the ventral skin defect is assessed. A dartos pedicle is developed, and the flap of dorsal penile skin is transferred ventrally along either side of the shaft. To date, 63 boys (ages 6 to 78 months) have undergone this type of penile skin reconstruction. Our transverse preputial flap has been used as an adjunct to hypospadias repair (28 boys), correction of chordee (26 boys), and release of concealed penis (9 boys). During a follow-up period of 6 to 74 months, 52 patients (83%) had a favorable cosmetic result. One patient experienced a significant loss of epithelium in the early postoperative course. Another patient developed a moderate penile torsion, which required subsequent revision of the repair. Two patients developed moderate scar indentations of the repair. Seven patients demonstrated a moderate redundancy of the flap with time. The transverse preputial flap is a reliable and cosmetically superior alternative to ventral skin coverage in hypospadias surgery, repair of chordee, and in the release of concealed penis.
Asunto(s)
Hipospadias/cirugía , Colgajos Quirúrgicos , Niño , Preescolar , Estudios de Seguimiento , Humanos , Lactante , Masculino , Pene/cirugía , Complicaciones Posoperatorias/cirugía , Reoperación , Técnicas de Sutura , Resultado del TratamientoRESUMEN
There is a paucity of research regarding the contribution of "low-cost" technologies to the escalation of medical costs in the United States. We examined total charges for medical and surgical supplies (MSS) among all hospitalized Medicare beneficiaries in 1994; a total of US $16.8 billion was spent on MSS, or $1,397 per hospitalization. For selected surgical procedures, both the proportion of total hospital charges attributed to MSS and the mean charge per hospitalization were considerably higher. Concerns regarding excessive payments for MSS and the lack of accountability by the Medicare program are discussed. Itemization of MSS supplies may serve to eliminate wasteful use and lead to decreased costs.
Asunto(s)
Equipos y Suministros de Hospitales/economía , Medicare Part A/economía , Procedimientos Quirúrgicos Operativos/economía , Estudios Transversales , Precios de Hospital , Costos de Hospital , Humanos , Estudios Retrospectivos , Equipo Quirúrgico/economía , Estados UnidosRESUMEN
We present the first report of neurogenic lower urinary tract dysfunction associated with neurosarcoidosis. Urodynamic findings of detrusor hyperreflexia with detrusor-sphincter dyssynergia correlate with this patient's magnetic resonance imaging (MRI) examination which found intramedullary involvement at the mid-thoracic level.
Asunto(s)
Imagen por Resonancia Magnética , Sarcoidosis/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Tomografía Computarizada por Rayos X , Vejiga Urinaria Neurogénica/diagnóstico , Urodinámica/fisiología , Adulto , Femenino , Humanos , Sarcoidosis/fisiopatología , Médula Espinal/patología , Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/fisiopatología , Vejiga Urinaria Neurogénica/fisiopatologíaRESUMEN
Extensive structure activity analysis has allowed us to identify specific residues in the glucagon sequence that are responsible for either receptor recognition or signal transduction. For instance, we have demonstrated that aspartic acid 9 and histidine 1 are essential for activation, and that an ionic interaction between the negative carboxylate and the protonated imidazole may contribute to the activation reaction at the molecular level. In the absence of the carboxylic group at position 9, aspartic 21 or aspartic 15 might furnish distal electrostatic effects to maintain partial agonism. Further investigation established that each of the 4 serine residues in the hormone play distinct roles. Serine 8 provides an important determinant of binding. Whereas neither serines 2, 11, nor 16 are required for receptor recognition. We have shown that serine 16 is essential for signal transduction and thus have identified it to be the third residue in glucagon to participate in a putative catalytic triad together with aspartic 9 and histidine 1, in the transduction of the glucagon response. In this work, we utilized insights into the functional significance of particular residues in the peptide appropriated from our structure-function assignments, as the basis of a molecular approach for the design of active-site directed antagonists of glucagon. The importance as well as the accuracy of our findings are confirmed by the synthesis of a series of improved glucagon antagonists based on replacements at positions 1, 9, 11, 16, and 21. The inhibition index, (I/A)50, of our best antagonist des-His1-[Nle9-Ala11-Ala16]glucagon amide, has been improved 10-fold over the previous best glucagon inhibitor.