Medizin - Open Access LMU - Teil 02/22 Ludwig-Maximilians-Universität München

Urinary excretion of nonesterified (NEC) and total cholesterol (TC) has been determined in 137 healthy individuals with a range (2 SD) of 0.26-2.2 mg/24 hours NEC and 0.3-3.0 mg/24 hours TC. 264 patients with various internal diseases revealed normal values of NEC and TC; neoplasias, diseases of the kidney and prostatic adenoma with residual urine had been excluded with reasonable certainty. There was no correlation between urinary cholesterol excretion and cholesterol plasma levels. In papilloma of the bladder (n = 16) NEC hyperexcretion was present in 56%; elevated levels of TC were determined in 68%. In carcinoma of the bladder, T1N0M0-T2N0M0 (n = 28), hyperexcretion of NEC occurred in 50% and of TC in 64%. In advanced clinical stages of the disease, T3N0M0-T4N4M1d (n = 21), elevated values of NEC were detected in 76% and of TC in 90%. Since all macroscopically blood contaminated urinary samples had been excluded, a determination of total urinary cholesterol excretion may be valuable in the diagnosis of papilloma or carcinoma of the bladder in the absence of macrohematuria. Occult blood in urine was present in 33 of the 65 patients with papilloma or carcinoma of the bladder, which was associated in 26 cases with elevated urinary total cholesterol. 32 patients revealed a negative test for occult blood in urine. In 22 of these, hyperexcretion of urinary total cholesterol was observed, indicating diagnostic sensitivity of this parameter for papilloma and carcinoma of the bladder even in the absence of microhematuria. However, one has to regard that elevated urinary cholesterol levels could also occur in other carcinomas of the urogenital system, prostatic adenoma with residual urine and kidney diseases.

ELECTRICAL stimulation of presynaptic fibres to the so-called AH1 or type II2 myenteric neurones in guinea pig small intestine evokes a slow excitatory postsynaptic potential (e.p.s.p.) characterised by long-lasting depolarisation associated with increased membrane resistance and augmented excitability3. Two substances have been implicated as possible neurotrans-mitters for the slow e.p.s.p. Katayama and North reported that application of substance P to myenteric neurones mimicked the slow e.p.s.p.4, and J.D.W. and C.J.M. presented several lines of evidence for serotonin as the transmitter substance5,6. We now report that methysergide, a drug which abolishes both the slow e.p.s.p. and the action of exogenous serotonin5,6, does not affect the action of substance P on guinea pig myenteric neurones. The results suggest that substance P is unlikely to be the neuro-transmitter which mediates the slow e.p.s.p.

Urinary excretion of nonesterified (NEC) and total cholesterol (TC) has been investigated in 79 patients with prostatic adenoma (BPH) and 48 patients with carcinoma of the prostate. Normal range of NEC was determined in 62 healthy individuals and was found to be 0.26-2.2 mg/24 hours (2 SD) with a mean value of 0.76 mg/24 hours. TC ranged from 0.3-2.9 mg/24 hours with a mean value of 0.92 mg/24 hours. In benign prostatic hyperplasia normal values for NEC and TC were determined in stages without residual urine. In contrast patients with BPH and residual urine showed elevated NEC in 42.1% and elevated TC in 61.4%. In prostatic carcinoma NEC hyperexcretion was present in 44.8% of stage A and B and in 52.6% of stage C and D. TC was elevated in 52.2% and 63.2%, respectively. Simultaneous determination of NEC and serum acid phosphatase (SAP) gave a pathologic result of at least one parameter in 51.7% of stage A and B and in 84.2% of stage C and D. If TC and serum acid phosphatase were combined, percentage of elevated values increases to 62.1 of stage A and B and was identical with 84.2 of stage C and D. If BPH with residual urine and other known conditions of urinary cholesterol hyperexcretion in males, pluripotential malignant testicular neoplasms and diseases of kidney and urinary tract, can be excluded with reasonable certainty, both parameters may be of value in diagnosis of prostatic cancer in even early clinical stages of the disease, especially in combination with the determination of SAP.