Plasma total homocysteine levels are associated with advanced leukoaraiosis but not with asymptomatic microbleeds on T2*-weighted MRI in patients with stroke

Both leukoaraiosis and asymptomatic microbleeds are associated with small-artery diseases. Although an association between hyperhomocysteinemia and leukoaraiosis has been reported, no studies have evaluated the association between total homocysteine (tHcy) level and presence of microbleeds in stroke patients. We evaluated the association between tHcy level and leukoaraiosis or microbleeds in stroke patients. In 102 patients with stroke (69.5 +/- 10.3 years old, 54 men and 48 women), microbleeds on T2*-weighted MR images were counted, leukoaraiosis on T2-weighted images was graded and fasting plasma tHcy concentrations were measured. Plasma tHcy level was significantly higher in patients with advanced leukoaraiosis than in those without advanced leukoaraiosis (13.9 +/- 4.6 micromol/l vs. 10.2 +/- 3.4 micromol/l, P < 0.0001). Plasma tHcy level was not significantly different in patients with microbleeds and those without microbleeds (11.3 +/- 4.1 micromol/l vs. 11.4 +/- 4.3 micromol/l, P = 0.9441). Elevated tHcy level is significantly and independently associated with advanced leukoaraiosis [odds ratio (OR), 1.330; 95% CI, 1.130-1.565] but not with the presence of microbleeds. Elevated tHcy level appears to be associated with ischemic small-artery disease rather than with bleeding-prone small-artery disease.

Combinations of the presence or absence of cerebral microbleeds and advanced white matter hyperintensity as predictors of subsequent stroke types

BACKGROUND AND PURPOSE

Previous studies have shown microbleeds to be a risk factor for intracerebral hemorrhage and white matter hyperintensity (WMH) to be a risk factor for ischemic stroke. This study was performed to determine whether combinations of the presence or absence of microbleeds and advanced WMH are risk factors for subsequent recurrent stroke types.

METHODS

In 266 patients with stroke, microbleeds on T2*-weighted MR images were counted, and WMH on T2-weighted images was graded. Patients were divided into 4 groups by the combinations of the presence or absence of microbleeds and advanced WMH and were followed up for stroke recurrence.

RESULTS

During a mean follow-up period of 564.8 +/- 220.5 days, 26 patients developed recurrent strokes, including 10 intracerebral hemorrhages and 16 ischemic strokes. Patients with microbleeds without advanced WMH (n = 42) developed only intracerebral hemorrhages (n = 8), and the recurrence rate of intracerebral hemorrhage in those patients estimated by the Kaplan-Meier method was the highest in the 4 groups (14.3% in 1 year and 21.2% in 2 years). In contrast, patients with advanced WMH without microbleeds (n = 39) developed only ischemic strokes (n = 6), and the estimated recurrent rate of ischemic stroke in those patients was the highest in the 4 groups (10.5% in 1 year and 17.4% in 2 years). Cox proportional hazards regression analysis revealed that microbleeds were associated with intracerebral hemorrhage (hazard ratio [HR], 85.626; 95% confidence interval [CI], 6.344-1155.649) and that advanced WMH was negatively associated with intracerebral hemorrhage (HR, 0.016; 95% CI, 0.001-0.258). Advanced WMH was associated with ischemic stroke (HR, 10.659; 95% CI, 2.601-43.678).

CONCLUSION

It appears that patients at high risk of subsequent intracerebral hemorrhage or ischemic stroke can be identified by combinations of the presence or absence of microbleeds and advanced WMH.

Short Communication: Amino Acids Antagonistic to the Amino Acids Inhibitory for Growth Rate of Mixed Ruminal Bacteria

Antagonism of some amino acids (AA) to the inhibitory effects of other AA (Ile, Phe, and Thr) on the growth rate of mixed ruminal bacteria was investigated. In vitro growth rate of the mixed ruminal bacteria was inhibited when the 3 inhibitory AA (1 mM each) were each added to individual control treatments in which an ammonium salt was included as a sole N source. The inhibitory effect caused by Ile was relieved by addition of Leu or Val (equimolar to Ile), and no significant inhibition was shown when both Leu and Val were added together with Ile. The growth inhibition caused by Phe was also alleviated by supplementing with Trp, and was completely negated by adding Tyr. The inhibitory effect of Thr, on the other hand, was not affected by addition of Lys or Met (which are synthesized using a common pathway with Thr), but was mitigated by supplementation with Glu, Ser, Val, Ala, or Gln. Among the antagonistic AA, Leu, Val, Trp, Tyr, and Glu were indispensable for the maximum growth rate of the ruminal bacteria under the experimental condition of supplementation of amino-N, the removal of which from a mixture of 20 protein AA caused the growth rate to decline. Removals of Ile along with Leu or Val or both, of Phe along with Trp or Tyr, and of Thr along with Glu recovered the promotion of bacterial growth rate. It was concluded that inhibitions of the bacterial growth rate caused by Ile, Phe, or Thr could be antagonized by some other AA (Leu, Val, Tyr, Trp, or Glu), and the role of these latter AA as relievers of the inhibitory effects could explain why they are indispensable for maximum growth rate of ruminal bacteria.

Significance of serum soluble thrombomodulin level in acute cerebral infarction

The purpose of the present study was to investigate sequential changes in serum soluble thrombomodulin (sTM) concentrations in patients with acute cerebral infarction (ACI), and to correlate sTM concentrations with the severity of ACI evaluated by Japan Stroke Scale. Eighty-three consecutive patients with ACI were enrolled, and blood examinations were carried out soon after admission and 1 month after. sTM concentrations at admission in patients with cardioembolic infarction (3.2 +/- 1.2 ng/ml) were significantly lower than those of lacunar infarction (3.9 +/- 1.2) (P < 0.05). Serial examinations revealed that sTM concentrations increased significantly 1 month after admission (3.8 +/- 1.2), compared with those at admission (3.6 +/- 1.2) (P = 0.02). Of three ACI subtypes, sTM concentrations during 1 month significantly increased in atherothrombotic infarction (P = 0.002) or, not significantly, in cardioembolic infarction (P = 0.09). The sTM concentrations at admission showed a significant inverse correlation with the severity of ACI (P = 0.04). Although sTM concentrations serve as a useful marker for endothelial cell damage, they are decreased in patients with severe ACI, especially in atherothrombotic and cardioembolic infarctions. Lower sTM concentrations may play some important role in disease progression or in the recurrence following ACI, although the exact mechanism of this unique result should be clarified.

Methane oxidation and its coupled electron-sink reactions in ruminal fluid

AIMS

This study was conducted to investigate the occurrence of methane oxidation in the rumen, and to identify the electron-sink reaction coupled to the oxidation if it occurred.

METHODS AND RESULTS

Mixed ruminal microbes taken from sheep were incubated with 13CH4. Oxidation of methane, estimated from the flux of 13C to CO2 and microbial cells, occurred, but represented only 0.2-0.5% of the methane produced. Methane oxidation was suppressed by the presence of oxygen, and was also inhibited by 2-bromoethane-sulphonate, and molybdate, but not by tungstate.

CONCLUSION, SIGNIFICANCE AND IMPACT OF THE STUDY

Methane could be oxidized anaerobically in the rumen by reverse methanogenesis in consort with sulphate reduction.

Detection of Proteobacteria from the rumen by PCR using methanotroph-specific primers

AIMS

To detect Proteobacteria, including methanotrophs, from the rumen fluid and the bacteria inhabiting the rumen epithelium.

METHODS AND RESULTS

Proteobacteria inhabiting the rumen were detected by PCR using methanotroph-specific primers. The detected Proteobacteria were divided into clusters A, B, and C in addition to one clone, which was distinct from the clusters and closely related to Nitrosomonas sp. The clusters A, B, and C were close to Succinivibrio dextrinosolvens, Enterobacter cloacae, and Actinobacillus minor, respectively. The clones obtained from the rumen fluid each belonged to cluster A or B. The clones obtained from the rumen epithelium belonged to cluster B or C or to Nitrosomonas sp.

CONCLUSIONS

It has been assumed that the rumen fluid and the rumen epithelium host different populations of Proteobacteria. Moreover, detection of Nitrosomonas from the rumen epithelium would indicate the possibility that the bacterium oxidizes ammonia and methane on the rumen surface.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings suggest that the rumen fluid and the epithelium support different microbial populations, which would play specific roles in rumen function. Future study should focus on the relationship between these communities and physiological functions in the rumen.

Stimulatory and inhibitory effects of protein amino acids on growth rate and efficiency of mixed ruminal bacteria

Mixed ruminal bacteria were incubated in vitro with glucose, xylose, cellobiose, and various protein amino acids replaced isonitrogenously with 25% (i.e., 25 mg of N/L) of ammonia-N, to determine the growth rate and the amount of sugar consumed in the exponential growth phase. The growth rate and efficiency (grams of bacteria per gram of sugars) increased by 46 and 15%, respectively, when a mixture of 20 amino acids was added. On the other hand, neither growth rate nor efficiency increased when any one of these amino acids was added singly, except for Glu and Gln, each of which produced significant but small improvements. The stimulatory effect of the combined amino acids on bacterial growth declined when each of Leu, Trp, Tyr, Glu, Met, Phe, and Val was removed from the original group of 20. When a mixture of only these seven amino acids was used as a supplement, their stimulatory effects on growth rate and efficiency were only 21 and 25%, respectively, of the effects that the mixture of 20 amino acids showed. The effects increased to 76 and 72% on growth rate and efficiency, respectively, when Gly, Cys, and His were supplied in addition to the seven amino acids. The growth rate and efficiency of the ruminal bacteria were inhibited by an addition of each of Ile, Thr, Cys, Phe, Leu, Lys, or Val to ammonia-N, and the effects of the first five of these amino acids were highly significant. Isoleucine, threonine, and phenylalanine were each inhibitory even at a low concentration (1 mg of NL), while cysteine and leucine showed inhibitory effects at higher concentrations (more than 10 mg of N/L). A higher growth rate of the ruminal bacteria when supplemented with amino acid mixtures was accompanied with a higher growth efficiency, which was attributable to a relatively smaller proportion of energy expended on maintenance according to the Pirt derivation.

Sequential changes in von Willebrand factor and soluble thrombomodulin in acute ischemic stroke

The purposes of the present study were to investigate sequential changes in plasma von Willebrand factor (vWf) activities and serum soluble thrombomodulin (sTM) concentrations, compared with white blood cell (WBC) counts, and to disclose the different roles of vWf and sTM in acute ischemic stroke. Forty-three acute ischemic stroke patients admitted to our hospital within 48 hours from onset were enrolled. Plasma vWf activities, serum sTM concentrations, and WBC counts were measured at the acute stage and 1 and 6 months after admission. The time course study revealed that vWf activities increased more markedly 1 month after admission than at the acute stage. However, sTM concentrations were low at the acute stage and increased sequentially at 1 month (not significantly) and 6 months (significantly) after admission. In contrast, elevated WBC counts at the acute stage decreased significantly at 1 and 6 months after admission. Raised vWf activities 1 month after admission were suggested to occur through continuous endothelial dysfunction or repair and platelet activation, compared with the acute stage, and decreased sTM at the acute stage through down-regulation of sTM synthesis by acute inflammatory response after acute ischemic stroke, compared with the chronic stage.

Tympanoplasty with and without mastoidectomy for non-cholesteatomatous chronic otitis media

OBJECTIVES

Cases of non-cholesteatomatous chronic otits media (COM) were reviewed to determine whether mastoidectomy is helpful when combined with tympanoplasty for these conditions.

STUDY DESIGN

A retrospective analysis of 251 ears with non-cholesteatomatous COM operated on by one surgeon (Y.M.) in an 11-year period was conducted.

METHODS

Patients in group A (n = 147) were treated by tympanoplasty with mastoidectomy. Patients in group B (n = 104) were operated on without mastoidectomy.

RESULTS

Graft success rates were 90.5% in group A and 93.3% in group B. There was no statistically significant difference. Graft success rates of discharging ears were 90.0% in group A and 85.7% in group B. Graft success rates of dry ears were 90.7% in group A and 94.4% in group B. There was no statistically significant difference between discharging ears and dry ears. The rates of the postoperative air-bone gap within 20dB were 81.6% in group A and 90.4% in group B, without a statistically significant difference.

CONCLUSIONS

Mastoidectomy is not helpful in tympanoplasty for non-cholesteatomatous COM, even if the ear is discharging.

[An analysis of characters and changes of the blood pressure in 29 cases on recurrence of cerebral infarction]

We investigated changes of the blood pressure in 29 stroke patients before stroke recurrence and after recurrence. Additional antihypertensive drugs were not administered to all patients after stroke recurrence. Twenty-five lacunar infarct patients and 4 atherothrombotic infarct patients were included in this study. A significant difference was observed between the systolic blood pressure(SBP) within 4 weeks before recurrence and that just after recurrence(132.8 +/- 17.2 mmHg vs. 157.4 +/- 21.3 mmHg, Wilcoxon rank sum test, p < 0.001), or between the SBP just after and 2 weeks after stroke recurrence(157.4 +/- 21.3 mmHg vs. 138.0 +/- 18.3 mmHg, Wilcoxon rank sum test, p < 0.001). The similar difference was found in the diastolic blood pressure(DBP) or in the mean arterial blood pressure(MABP). There was no significant difference in the SBP, the DBP or the MABP between the patients before and 2 weeks after the stroke recurrence. These results suggested that the elevation of the blood pressure at recurrence decreased spontaneously to the pre-recurrence level of the blood pressure in about 2 weeks.

Degradation of benzyl ether bonds of lignin by ruminal microbes

We examined microbial activity in the rumen to cleave benzyl ether bonds of lignin model compounds that fluoresced when the bonds were cleaved. 4-Methylumbelliferone veratryl ether dimer was degraded completely within 8 h even in the presence of fungicidal antibiotics, but no significant degradation occurred with bactericidal antibiotics. Degradation of a phenolic beta-O-4 trimer incorporating 4-methylumbelliferone by a benzyl ether linkage was stimulated by ruminal microbes, although its corresponding non-phenolic model compound, 1-(4-ethoxy-3-methoxyphenyl)-1-O-(4-methylumbelliferyl)-2-(2-methoxyp henoxy)-3-propanol, was not degraded. A coniferyl dehydrogenation polymer bearing fluorescent beta-O-4 benzyl ether that contains both phenolic and non-phenolic benzyl ether bonds was partially degraded (about 20%) in 48 h. These results suggest that ruminal microbes decompose benzyl ether linkages of lignin polymers under anaerobic conditions.

Relationship between the clinical manifestations, computed tomographic findings and the outcome in 80 patients with primary pontine hemorrhage

The relationship between the clinical manifestations, computed tomographic (CT) findings and the outcome in 80 patients with primary pontine hemorrhage (PPH) was analyzed to clarify factors predicting the outcome. Patients were 58 males and 22 females (60. 5+/-12.9 years old) with PPH. Correlations between the clinical manifestations, CT findings and the outcome was assessed with multivariate regression analysis. The initial level of consciousness and the transaxial size of the hematoma on CT were strongly related to the outcome. In patients with small hematoma (with the transaxial size </=20 mm), pupillary abnormalities of onset and acute hydrocephalus were related to the outcome of PPH.

Cellobiose transport by mixed ruminal bacteria from a Cow

The transport of cellobiose in mixed ruminal bacteria harvested from a holstein cow fed an Italian ryegrass hay was determined in the presence of nojirimycin-1-sulfate, which almost inhibited cellobiase activity. The kinetic parameters of cellobiose uptake were 14 microM for the Km and 10 nmol/min/mg of protein for the Vmax. Extracellular and cell-associated cellobiases were detected in the rumen, with both showing higher Vmax values and lower affinities than those determined for cellobiose transport. The proportion of cellobiose that was directly transported before it was extracellularly degraded into glucose increased as the cellobiose concentration decreased, reaching more than 20% at the actually observed levels of cellobiose in the rumen, which were less than 0.02 mM. The inhibitor experiment showed that cellobiose was incorporated into the cells mainly by the phosphoenolpyruvate phosphotransferase system and partially by an ATP-dependent and proton-motive-force-independent active transport system. This finding was also supported by determinations of phosphoenolpyruvate phosphotransferase-dependent NADH oxidation with cellobiose and the effects of artificial potentials on cellobiose transport. Cellobiose uptake was sensitive to a decrease in pH (especially below 6.0), and it was weakly but significantly inhibited in the presence of glucose.

[A case of primary transitional cell carcinoma of the prostate]

We report a rare case of primary transitional cell carcinoma of the prostate. A 66-year-old man was referred to our hospital with the chief complaints of pollakisuria and residual urine sensation on January 21, 1998. Under a preoperative diagnosis of benign prostatic hyperplasia, transurethral resection of the prostate was performed. Histopathological examination revealed grade 3 transitional cell carcinoma. Then the transrectal needle biopsy of the prostate and random biopsy of the urinary bladder were performed. Since no metastatic tumors or tumor cells were detected in either the prostate or urinary bladder or any other organs, this patient was diagnosed with primary transitional cell carcinoma of the prostate. Three courses of adjuvant chemotherapy (M-VAC) were performed, and tumor recurrence was not recognized 9 months after the operation. This is the 35th case of primary transitional cell carcinoma of the prostate in the Japanese literature.

High incidence of meningioma among Hiroshima atomic bomb survivors

Since the atomic bomb explosions in Hiroshima and Nagasaki, high incidences of leukemia, thyroid cancer and other tumors have been reported as atomic bomb-induced tumors. We investigated the incidence of meningioma among Hiroshima atomic bomb survivors. Sixty-eight patients surgically treated for meningioma who had been within 2.0 km of the hypocenter of the explosion were identified. Six hundred and seven non-exposed patients with meningioma were also studied. Treatment dates were from 1975 to 1992. The incidences of meningioma among 68 subjects within 2.0 km and 607 non-exposed patients were 8.7 and 3.0 cases per 10(5) persons per year, respectively. The incidences of meningioma among the survivors of Hiroshima in 5-year intervals since 1975 were 5.3, 7.4, 10.1, and 14.9, respectively. The incidences of meningioma classified by distances from the hypocenter of 1.5-2.0 km, 1.0-1.5 km and less than 1.0 km were 6.3, 7.6 and 20.0, respectively. The incidences of meningioma classified by doses to the brain of 0-0.099 Sv, 0.1-0.99 Sv and more than 1.0 Sv were 7.7, 9.2 and 18.2, respectively. The incidence of meningioma among Hiroshima atomic bomb survivors has increased since 1975. There was a significant correlation between the incidence and the dose of radiation to the brain. The present findings strongly suggest that meningioma is one of the tumors induced by atomic bombing in Hiroshima.

[The influence of dietary lipids on nephrolithiasis in rats]

PURPOSE

The influence of dietary lipids on nephrolithogenesis is unclear. In the present study, I investigated the role of dietary lipids concerning both the etiology and the prevention of nephrolithiasis using 9-week-old male Wistar rats.

METHODS

Study 1: The rats were divided into five groups and reared on standard, low protein, high protein and high cholesterol diets for 23 weeks. Study 2: The effects of cholesterol on nephrolithiasis was examined. The animals were given a 30 intraperitoneal injection of 2 ml of 8.5% calcium gluconate. Study 3: A nephrolithiasis model was prepared by intraperitoneal administration of 40 mg/kg of glyoxylic acid and 0.25 microgram of vitamin D3 daily for 2 weeks. The inhibitory effects of eicosapentaenoic acid (EPA) on nephrolithiasis were studied.

RESULTS

Study 1: In the groups given the high protein and high cholesterol diets, an increase in renal osteopontin-mRNA, one of the major matrix ingredients of stones containing calcium, was observed. Study 2: Microlith was more frequently observed in the high cholesterol group than in the standard diet group. Study 3: In the EPA group, lithiasis was less extensively than in the groups administered distilled water or olive oil, and this was assumed to be caused by factors other than inorganic substances such as calcium and oxalic acid in the urine. When the renal tissue specimens in Studies 2 and 3 were examined, initial calcium deposition was found to start from the basement membrane of renal tubular cells and gradually spread throughout the cells.

CONCLUSION

These results suggested that cholesterol is a risk factor in nephrolithiasis, and EPA is effective in its prevention. The elimination of hyperlipidemia should be included in dietary instructions for nephrolithiasis patients.

[Rare intra-abdominal complications of a ventriculoperitoneal shunt: report of three cases]

Three cases of rare intra-abdominal complications of ventriculoperitoneal shunt (VPS) surgery are reported. Case 1 was a 32-year-old male who had undergone VPS surgery for hydrocephalus following meningitis on July 10, 1980. Two weeks later he developed fever and a cystic mass about 10 cm in diameter in the right hypochondrium. Shuntography and a barium enema study demonstrated a pseudocyst at the distal end of the shunt. The cyst wall was excised, the peritoneal tube removed, and VPS converted to a ventriculoatrial route following which the pseudocyst resolved. Case 2 was a 49-year-old female who developed hydrocephalus following subarachnoid hemorrhage, and VPS surgery was performed on March 10, 1989. Two weeks later, she developed fever and right upper abdominal pain. Abdominal x-ray and CT scan revealed a right subdiaphragmatic abscess. The abscess was drained and the shunt system was removed on April 4. VPS was placed again on April 21 without further complications. She was symptom free for the next 7 years. Case 3 was a 57-year-old female who presented in a semicomatose state after falling from bed on May 5, 1995. CT scan showed left-sided acute subdural hematoma (ASDH) for which surgery was performed. Her neurological status improved postoperatively. She eventually developed hydrocephalus and left-sided subdural effusion for which right VPS and left subduroperitoneal shunt (SPS) surgery was performed on January 25, 1996. The peritoneal end of the tube of the SPS protruded out of the anus one and a half year after shunt placement. The entire SPS system was removed as there was no more collection in the subdural space. We reviewed the literature and discussed the pathophysiology involved in the development of intraabdominal complications following VPS.

Surgical treatment of distal cervical internal carotid artery aneurysm

We report on a 55-year-old male with an internal carotid artery aneurysm at the level of the second cervical vertebra. Since ant-coagulation therapy failed to prevent the ischemic attack, aneurysmectomy with arterial reconstruction was performed. Vertical mandibular osteotomy allowed a wide working space in deep operative field. This technique is considered to be useful in surgery for aneurysms of the extracranial distal internal carotid artery.

Association between carotid atherosclerosis and hemostatic markers in patients with cerebral small artery disease

The purposes of this study were to investigate the association between carotid atherosclerosis and hemostatic markers, and to elucidate the difference in hemostatic markers between intima-media thickening and plaque formation in patients with cerebral small artery disease. We investigated carotid atherosclerosis by assessing diffuse intima-media thickness measurements and localized plaque using B-mode ultrasonography, and we measured the concentrations of plasma fibrinogen, beta-thromboglobulin and platelet factor 4 as markers for platelet activation, and the activity of plasma von Willebrand factor as a marker for endothelial damage. The intima-media thickness was significantly associated with age, male sex, the concentrations of plasma beta-thromboglobulin and platelet factor 4, and the activity of plasma von Willebrand factor. The plaque score showed a significant association with male sex, the concentration of fibrinogen, and the activity of plasma von Willebrand factor. These results may indicate that underlying mechanisms are not the same between the intima-media thickness and plaque formation. We suggest that hemostatic markers could reflect the severity of carotid atherosclerosis in patients with cerebral small artery disease, and that preventive antiplatelet therapies against brain infarction might be necessary for patients with severe carotid atherosclerosis.

[Endopyelotomy with the ureteral cutting balloon device for ureteropelvic junction obstruction]

BACKGROUND

This study investigated the feasibility of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction.

METHODS

Six patients (male: 3, female: 3, age: 6-18) with UPJ obstruction and abdominal pain as the chief complaint, were treated by the Acucise ureteral cutting balloon device (flexible ureteral catheter, 7 Fr) under epidural or general anesthesia (for the 6-year-old girl only). After cutting the stenotic area electrically and posteriolaterally using a 3 cm cutting wire and dilation by the balloon to a maximum of 24 Fr for 10 seconds, a 6/10 Fr (for children) or 7/14 Fr (for adults) endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. After removing the ureteral catheter transurethrally, the results, including the patency of the UPJ, of this procedure were evaluated by intravenous pyelography and the disappearance of the chief complaint, abdominal pain, 12 weeks after removing the ureteral catheter.

RESULTS

Mean operative time was 47 (25-90) minutes and the hospital stay after the operation was 5.3 (3-14, median: 4) days. There was no transfusion or emergent open operation for uncontrolled bleeding in this series. The results 20 months after the operation: improvement of hydronephrosis was shown in 4 patients (66.7%) on intravenous pyelography and abdominal pain disappeared in all patients.

CONCLUSION

UPJ obstruction may be easily and safely treated by retrograde endopyelotomy with the Acucise ureteral cutting balloon device. The principal potential advantage of this procedure is reduced morbidity compared to that with antegrade or retrograde endopyelotomy by endoscopy.

Expression of neurite outgrowth factor and gicerin during inner ear development and hair cell regeneration in the chick

Several cell adhesion molecules are expressed in the developing inner ear. The present study focused on gicerin, a novel member of the immunoglobulin superfamily, in an attempt to improve our understanding of the development and regeneration of chick inner ear. Gicerin is known to homophilically interact with itself and to bind to neurite outgrowth factor (NOF). The data collected herein show that gicerin is highly expressed in auditory epithelium and acoustic ganglion during early embryogenesis. The immunoreactivity of gicerin in the auditory epithelium decreases more rapidly than that in the acoustic ganglion as the mature hair cells become distinguishable. At the post-hatch stage, the expression of gicerin is not observed. In contrast, NOF was expressed on the basement membranes around the auditory epithelium, and in the acoustic ganglion during development and after birth, but not in the auditory epithelium. Following noise damage, gicerin is transiently re-expressed on the damage receptor epithelium when active cell proliferation is observed in the epithelium. This positive reaction immediately disappears as immature short hair cells appear. These results suggest that gicerin may be associated with cell proliferation in the auditory epithelium, and play a role in neurite extension of the acoustic ganglion cells in conjunction with NOF.

Glucose transport by mixed ruminal bacteria from a cow

The glucose transport of mixed ruminal bacteria harvested from a holstein cow fed 5.0 kg of Italian ryegrass and 1.5 kg of flaked corn a day was investigated. The Eadie-Hofstee plot characterized two transport systems: a high-affinity, low-velocity system and a low-affinity, high-velocity system. The former system (K(m) = 16 microM; Vmax = 2.2 nmol/min/mg of protein) is considered dominant under this feeding condition based on the glucose concentration in the rumen (< 1 mM). In light of the facts that the protonophore SF6847 and the lipophilic triphenylmethyl phosphonium ion had no effect on the high-affinity system and an artificially generated proton gradient and electrical potential across the cell membrane did not increase glucose transport, a proton motive force is not be involved in the system. On the other hand, from the facts that chlorhexidine inhibited about 90% of the high-affinity system while iodoacetate showed no significant effect, and a high phosphoenolpyruvate-dependent phosphorylation of glucose was actually shown, the phosphoenolpyruvate-dependent phosphotransferase system is considered the main system in the high-affinity system. Moreover, as shown by the facts that harmaline inhibited about 30% of the high-affinity system and the artificially generated sodium gradient across the cell membrane significantly stimulated glucose transport, this system also includes sodium symport to some degree. The high-affinity system was sensitive to a decrease in pH (< 6.5) and was inhibited by the presence of sucrose, mannose, and fructose.

[Magnetic resonance imaging of brainstem lesions in a case of neuro-Behçet disease]

We reported a 28-year-old man with multiple lesions in the brainstem which were clearly identified and followed up with MRI. He had been treated for Behçet uveitis using cyclosporine and colchicine during the past 5 years, and he acutely presented with fever and headache, followed left hemiparesis, dysarthria and dysphagia. MRI on admission revealed multiple lesions in the ventral pontine region which showed mixed-intensity on T1WI, high-intensity on T2WI and enhancement with Gd-DTPA. His clinical symptoms spontaneously and gradually improved, but more rapidly improved due to additional administration of corticosteroid. The lesions in the brainstem became smaller and finally rudimentary during two months after the onset of neurological symptoms.

Expression of highly polysialylated NCAM (NCAM-H) in developing and adult chicken auditory organ

Neural cell adhesion molecule (NCAM) is highly polysialylated (NCAM-H) in developing tissues, and recent findings suggest that NCAM-H is more essential for neural development than poorly sialylated NCAM (NCAM-L). In order to understand the precise role of NCAM-H in developing and adult inner ears, the immunohistochemical localization of NCAM-H in developing and adult chicken inner ears was examined using a monoclonal antibody which is only specific for NCAM-H. Immunoreactivity of NCAM-H was initially observed on acoustic ganglion at stage 24, when peripheral (afferent) fibers begin to emerge from the ganglion cells. At stage 38, when peripheral fibers form synapses with hair cells, NCAM-H was observed on peripheral fibers and the base of hair cells in the auditory epithelium. At stage 42, NCAM-H on nerve fibers disappeared, and only some acoustic ganglion cells were still positive for NCAM-H. This immunostain on ganglion cells was retained after birth. These data are consistent with the hypothesis that NCAM-H specifically regulates the afferent nerve fibers' growth and synaptogenesis with hair cells during inner ear development and may be associated with processing of auditory information and neuronal plasticity.

A pediatric case of ureteropelvic junction obstruction treated with retrograde endopyelotomy

To determine the feasibility of retrograde endopyelotomy in the management of pediatric ureteropelvic junction (UPJ) obstruction, we treated one girl aged 6 years with the Acucise cutting balloon devise for symptomatic UPJ obstruction. The Acucise catheter (7 Fr, flexible) was placed by a cystoscope over a guide wire with fluoroscopic guidance under general anesthesia. After cutting the stenotic area electronically and dilation until 24 Fr for 10 seconds, a 6/10 Fr endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. Total operating time was 45 minutes and the child was discharged 3 days after the operation. There were no acute complications and short-term, follow-up 8 months after the operative results were satisfactory as determined by intravenous pyelography and diuretic renogram. UPJ obstruction in children may be treated by retrograde endopyelotomy with the Acucise catheter as well as adults. The principal potential advantage of this procedure is reduced morbidity as compared with antegrade endopyelotomy.

[Unilateral dissection of the cervical portion of the internal carotid artery and ipsilateral multiple cerebral infarctions caused by suicidal hanging: a case report]

This paper presents a case of traumatic dissection of the unilateral internal carotid artery of the cervical portion caused by hanging. A 63-year-old man attempted suicide by hanging and was rescued immediately after. No neurological deficits were detected for the first 4 hours. But then, right hemiplegia, aphasia and disturbed consciousness suddenly developed. On the 2nd day, MRI revealed multiple infarctions in the left cerebral hemisphere. MR angiography demonstrated severe stenosis at the cervical portion of the left internal carotid artery due to dissection. The left middle cerebral artery was not demonstrated. The patient was conservatively treated with fibrinolytic agents and regained consciousness gradually. But aphasia and right hemiplegia remained. During the next few weeks, the stenosis at the ICA slightly improved and the MCA was completely recanalized. Extracranial Doppler sonography revealed chronological hemodynamic changes of mean flow velocity and pulsatility index at the proximal and distal portion of the ICA stenosis.

[Putaminal abscess occurring at the site of hemorrhage: a case report]

Brain abscesses following stroke have been reported only rarely. We presented a case of putaminal abscess following putaminal hemorrhage. The patient was admitted to our hospital because of acute onset of left hemiplegia. The size of the hematoma was medium and the patient was conservatively treated. In about two months after the ictus, he became intermittently febrile and laboratory examinations suggested the presence of general infections including meningitis. Meanwhile, CT and MRI revealed clearly abscess formation at the site of the hematoma with remarkable brain edema. Cerebrospinal fluid analysis showed the findings of meningitis. On diagnosis of brain abscess, stereotactic exploration was performed and pus mixed with old blood was aspirated. Bacteriological study of the specimen demonstrated Morganella morganii. Postoperative course was uneventful and the abscess cavity gradually subsided following drainage and irrigation of the abscess cavity.

[Acute epidural hematoma of posterior fossa: comparative analysis between 20 cases in adults and 10 cases in children]

A comparative study of the clinical features was made among 30 patients, 10 children (less than 14) and 20 adults (older than 15) with traumatic acute epidural hematoma of the posterior fossa (PFEDH). The characteristic findings in both groups were as follows: 1) PFEDH accounted for 15% of 200 epidural hematoma cases. Incidence of PFEDH was 23.3% (10/43) in children and 12.7% (20/157) in adults. Thus, PFEDH is more common in children than in adults. 2) In seven out of 10 children, PFEDH was confined to the posterior fossa but in the other three children, PFEDH extended to the supratentorial area. On the other hand, in all the adult cases PFEDH extended over the supratentorial space. 3) Hematoma density was high in 5 out of 10 children and 18 in out of 20 adults. Mixed (including low) density occurred at a higher rate in children (50%) than in adults (10%). 4) Brain contusion associated with PFEDH was found by CT scan in 12 adult cases and one child case. Subarachnoid hemorrhage was found by CT scan in 4 adult cases. Subdural effusion was found by CT scan in 1 adult case. Thus, intracranial complications associated with PFEDH occurred in a significantly higher number in adults than in children. 5) 20 cases (4 children, 16 adults) of 30 underwent surgery, and 10 cases (6 adults, 4 children) were given conservative treatment. Results (GOS); GR was observed in 22 cases (in all 10 children and in 12 adults), and MD in 8 cases. There were no SD, VS or cases ending in death.

[Significance of the coagulation and fibrinolytic parameters as predictors for carotid atherosclerosis]

We investigated the relation between atherosclerosis of common carotid artery measured by B-mode ultrasound sonography and vascular risk factors, in particular the coagulation and fibrinolytic parameters. A total of 118 patients without either hematological disease or symptomatic brain infarction are enrolled in this study. Vascular risk factors associated with increased intima-media thickness (IMT) of common carotid artery were advancing age, sex (male), systolic blood pressure and diastolic blood pressure. There was a significant correlation of IMT with the activity of von Willebrand factor (vW factor) which had a significant correlation with concentration of beta-thromboglobin (beta TG) and platelet factor 4 (PF4). It has been reported that vW factor is a useful parameter for the evaluation of the extent of vascular involvement. vW factor in plasma and in the vessel wall is known to contribute appreciably to the platelet adherence, and to play a major role in the platelet aggregation particularly at high shear stress. In this study, we showed that plasma vW factor might enhance platelet aggregation. In addition, we revealed that plasma vW factor might reflect the injury of carotid artery wall and serve as a significant predictor of carotid atherosclerosis. There was a significant correlation of IMT with concentration of fibrinogen (Fbg), suggesting Fbg may play a role in atherogenesis by affecting local blood flow especially at the bifurcation. We reconfirmed that Fbg is a significant indicator of carotid atherosclerosis. Concentrations of beta TG and PF4 were significantly correlated with IMT. They are useful parameters of platelet activation and elevated in various angiopathies. These results, therefore, indicate that beta TG and PF4 also reflect the injury of carotid artery wall, and could be markers for carotid atherosclerosis.

[A case report of chronic encapsulated intracerebral hematoma]

Chronic encapsulated intracerebral hematoma is a rare clinicopathological entity. The authors reported a case of a 52-year-old male who presented with progressive sensory disturbance of the left extremities three weeks prior to admission. Plain CT and MRI scans revealed a subcortical mass in the right temporal lobe associated with extensive peritumoral edema and intratumoral hemorrhage (mixed intensity on T1WI, low intensity on T2WI). There was a ring-like enhancement with GdDTPA. These findings strongly suggested metastatic melanoma associated with intratumoral hemorrhage. During the operation, the mass appeared partly at the surface of the brain and was easily extirpated totally. Histologically, the specimen showed chronic encapsulated hematoma with a thick, fibrous capsule and there was no evidence of neoplasm. The postoperative course was uneventful and follow up CT scan showed disappearance of the mass and the surrounding edema. The relevant literature was reviewed, and the pathogenesis of this entity was discussed.

[Long-term effect after total parathyroidectomy with autotransplantation for secondary hyperparathyroidism]

Although the short-term outcome of total parathyroidectomy combined with autotransplantation in cases of renal osteodystrophy has been reported by many investigators, few studies have been made on the long-term outcome of this surgical technique. We recently examined the long-term outcome of this surgery by following 19 cases for more than one year (range: 12-70 months, mean: 31.7 months). During the follow-up period, changes in subjective symptoms, biochemical parameters and bone mineral density (BMD) were monitored. At the end of the follow-up period, C-parathyroid hormone (C-PTH) and alkaliphosphatase (ALP) were significantly lower than their preoperative levels. Ca, P and %BMD showed no significant change from their preoperative levels, although %BMD tended to be higher than its preoperative level. Depending on the presence or absence of osteoarticular pain at the end of the follow-up period, the patients were divided into the improved group and the non-improved group. Of the 5 patients allocated to the non-improved group, 4 were female and only 1 was male. C-PTH and ALP were significantly higher in the non-improved group. %BMD was higher in the improved group than in the non-improved group, although this difference was not significant. In the non-improved group, 2 patients were suspected of having extra parathyroids, 1 was suspected of having recurrence, and 2 were suspected of having postoperative osteomalacia. Postoperative reduction in BMD was only seen in females, suggesting its relationship to postmenopausal osteoporosis.

[Indications of parathyroidectomy for bone disease associated with secondary hyperparathyroidism]

BACKGROUND

The indications and suitable operative time of parathyroidectomy for secondary hyperparathyroidism were discussed.

METHODS

From October 1978 to September 1994 parathyroidectomy was performed for 71 patients who had bone and/or joint pain due to secondary hyperparathyroidism. There were 37 men and 34 women (mean age 48.4 years). The duration of dialysis treatment before parathyroidectomy was 0.8 to 19 years, with a mean of 10.9 years.

RESULTS

Postoperative subjective improvement was noted in 69% of the patients. No significant difference was observed between the improved and non-improved groups regarding age and the duration of dialysis treatment. But the improvement rate in female patients was significantly lower than that in male patients.

CONCLUSION

Patients with high carboxyl-terminal PTH level and generalized fibrous osteitis were good suitable objects for parathyroidectomy. But, those with high serum aluminum level were unsuitable objects for it. Furthermore, 99mTc-Pyrophosphate bone scintigraphy and bone mineral determination using dual photon absorptiometry (DPA) or dual energy X-ray absorptiometry (DEXA) were proved to be valuable for patient selection for parathyroidectomy.

Regulation of the expression of OPN mRNA in the rat as an experimental model of renal stone disease

We have sequenced a cDNA of calcium oxalate urinary stone protein extracted with EDTA. cDNA sequences showed complete homology between urinary stone protein and human osteopotine (OPN, bone sialoprotein 1). In this study, we investigated the expression of OPN mRNA in rat kidney serving as experimental models for several conditions that are considered to be risk factors in human renal stone formation. In the renal stone formation model, the expression of OPN mRNA in the distal convoluted tubule of the kidney was enhanced compared with the control which was found sporadically positive by in situ hybridization. By Northern blot analysis, the expression of OPN mRNA was increased in pyelonephritis and hydronephrosis models compared with the control, but no changes were observed in dietary-acid or base-loading models. The expression of OPN mRNA was markedly inhibited in the renal stone formation model by concomitant administration of estradiol and/or progesterone.

[Familial occurrence of intracerebral cavernous angioma: report of cases in brothers]

Familial occurrence of intracerebral cavernous angioma has been rarely reported. We report two histologically verified cases of cavernous angioma among brothers and review relevant cases in the literature. Case 1 is that of a 3-year-old boy who suffered front acute onset of headache, vomiting, and tonic-clonic type seizure. CT revealed a well-demarcated tumor with partial hemorrhage in the left frontal lobe which was strongly enhanced with contrast Medium. Complete excision was carried out and the patient had a satisfactory clinical course and was able to be followed up for 13 years after the Surgery. Case 2 is that of a 17-year-old boy who was the elder brother of case 1 and presented with gradually increasing episodes of a psychomotor seizure which started at the age of 16. CT and MRI revealed a well-demarcated tumor in the left subcortical temporal lobe and an asymptomatic small calcified lesion in the left subcortical parietal lobe. The temporal tumor was totally excised and histologically diagnosed as cavernous angioma. The seizures gradually decreased and eventually disappeared one year after the surgery. This report reviews 13 previously reported cases, and surgical indication for asymptomatic cases.

[Spontaneous dissecting aneurysm of the superficial temporal artery: a case report]

Aneurysms of the superficial temporal artery are rare, and usually traumatic in origin. We present a very rare case of spontaneous dissecting aneurysm of the superficial temporal artery in a 46-year-old man. The patient had pulsatile headache in the right temporal region, and a pulsatile mass in the same region. His headache gradually worsened for which he came to our hospital. On examination, there was a pulsatile mass of 1.5cm x 3cm at the right temporal region, which disappeared when the main trunk of superficial temporal artery was compressed. There was no neurological abnormality. On computed tomographic examination, there was a spotty high density area in the right extracranial region corresponding to the right superficial temporal artery, which was strongly enhanced after contrast medium administration. On MRI examination, the same area showed high intensity, but at inner space there was signal loss on T1WI, T2WI and PDWI. Angiography showed an aneurysmal dilatation at the right superficial temporal artery and both the true lumen and the false lumen were recognized. Excision of the aneurysm under local anesthesia was performed. His complaints disappeared completely post-operatively, and the skin color of that region retained its normal texture. Histopathological examination of the specimen showed hypertrophic intima with fibroblasts, and absence of internal elastic lamina. There was hematoma outside of the intima, but no deposits of hemosiderin. On account of the above findings, the lesion was diagnosed as a spontaneous dissecting aneurysm of the superficial temporal artery.

[Influence of genetic factors on family history of upper urinary stones]

The family history between patients with upper urinary tract stones and healthy subjects was compared to evaluate the possible involvement of genetic factors in obtaining information through a questionnaire. The patients showed a significantly more marked history than the healthy subjects (p < 0.001). In particular, recurrent stone formers showed a significantly more marked history than single stone formers (p < 0.05). Compared with the healthy subjects, a more marked family history was observed in the parents, brothers and sisters, and children, but not in the spouse (p < 0.05-0.005). However, the family history was not affected by consanguineous marriage. A more marked family history was observed in patients with upper urinary tract stones, suggesting the involvement of genetic factors in the development of upper urinary tract stones. In particular, genetic factors seem to be more closely involved in recurrent stone formers.

[Ruptured distal anterior cerebral artery aneurysm and diagnostic dyspraxia: a case report]

A case of ruptured distal anterior cerebral artery aneurysm presenting with diagnostic dyspraxia is presented. A 54-year-old female was referred to our hospital with the complaint of sudden onset of headache followed by disturbance of consciousness. CT and MRI revealed subarachnoid hemorrhage with hematomas in the interhemispheric fissure and the supracallosal area, and CAG revealed a left-sided callosomarginal artery aneurysm. During and after hospitalization, she showed diagnostic dyspraxia characterized by behavior of both her hands opposite to what might be expected e.g. when she tried to pick up a bowl, both her hands moved forward and held it at once; she wiped her head and face with toilet paper after urination. At times her hands behaved in opposite ways. For example, while folding cloths, her right hand tended to fold them while the left hand tended to unfold them; when she put on a sweater, as the right hand put it on, the left hand took it off; when she put her shirt into her trousers, one hand pushed it in while the other hand pulled it out. This unusual behavior was considered to be caused by the impairment of the corpus callosum due to compression by the hematoma. It disappeared gradually over a period of one year. Involuntary motor behavior of the left hand while the right hand is in voluntary action is known as diagnostic dyspraxia. Although this symptom has rarely been reported so far in cases of ruptured distal anterior cerebral artery, it may become noticed more frequently through careful observation.

[Randomized study of initial treatment with radiation.MCNU or radiation.MCNU.interferon-beta for malignant glioma. Hiroshima Brain Tumor Study Group]

The efficacy of radiation.MCNU (MR group) or radiation.MCNU.interferon-beta (IMR group) for malignant glioma was studied by a randomized trial at numerous medical facilities. MR group was irradiated with 50-60 Gy and intravenously injected with 2 mg/kg of MCNU on the initial day of irradiation and 6 weeks later. IMR group was also given intravenous administration of interferon-beta at the dose of 2 x 10(6) IU/m2 for 5 serial-days every eight weeks. There was no difference in background between the two groups. The response rate in MR group and IMR group was 44.4% (4/9) and 30.0% (3/10), respectively, showing no significant difference. The resected tumor volume before the start of these regimens seemed to correlate the response to the treatment in both groups. The major toxicity was myelosuppression, especially using MCNU with interferon-beta. These results indicated that this combined therapy is effective for malignant glioma, and should be executed further trials and follow up study.

[A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer]

A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of the ascending colon cancer is reported. A 47-year-old woman complained of colic on right costa-vertebral angle. Excretory urograms showed right peripelvic extravasation and CT-scan showed urinoma formation around right kidney. Subsequent examination of right retrograde pyelo-ureterograms showed ureteral stenosis at sacro-iliac region. Operative findings revealed ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer, which was regarded as inoperable. There are a few reports of spontaneous peripelvic extravasation caused by a malignant tumor in Japanese literature. Twenty of them are reviewed.

[Two cases of paratesticular rhabdomyosarcoma]

Two cases of paratesticular rhabdomyosarcoma are reported. A 15-year-old boy was admitted in July, 1983, with a 3-week history of gradually increasing painless scrotal swelling on the right side. With the suspicion of testicular cancer, right radical orchiectomy was performed and pathological examination revealed an embryonal rhabdomyosarcoma of the paratesticular region. Chemotherapy and retroperitoneal lymphadenectomy were performed, and the latter revealed lymph node metastasis at the bifurcation of the aorta. Radiotherapy was not done because of adherent ileus. About 8 months after the orchiectomy, he died of recurrence at pelvic cavity and brain metastasis. A 6-year-old boy presented in March, 1985, with a complaint of right scrotal swelling that was painless and gradually increasing for about a month. Transinguinal exploration revealed a paratesticular neoplastic lesion and right radical orchiectomy was performed. Pathological diagnosis was paratesticular embryonal rhabdomyosarcoma. No evidence of metastasis was found by chest X-ray, excretory urogram, abdominal CT-scan or lymphangiography. As post-operative treatment, only chemotherapy was performed, and 9 months after the orchiectomy, the patient was asymptomatic. Ninety four cases of paratesticular rhabdomyosarcoma found in the Japanese literature are reviewed and mainly the policy of treatment is discussed.

[Combination chemotherapy of urothelial cancer with cisplatin, cyclophosphamide, doxorubicin and peplomycin: treatment of advanced cases and adjuvant chemotherapy after radical operation]

Cisplatin, doxorubicin, cyclophosphamide and peplomycin have been used in combination for urothelial cancer. Doxorubicin 30-40 mg/m2 and cyclophosphamide 300-400 mg/m2 were administered on day 1, cisplatin 12-15 mg/m2 daily for 5 days and peplomycin 4-6 mg/m2/day by continuous infusion for 5 days. Courses were given at 3-4-weekly intervals in principle. Eight patients with measurable locally advanced or metastatic disease were treated with this protocol, and four achieved partial remission (objective response 50%). None of the four patients with locally advanced disease showed any response, (three no change, one progressive disease). Another eight patients were treated with adjuvant chemotherapy after radical surgery. Of the four patients with high-grade (G3) and high-stage (pT3b-pT4) bladder cancer, three relapsed 7-14 months after surgery, leaving one who still remains disease-free after 8 months. These preliminary results seem to indicate that our protocol is insufficient for adjuvant chemotherapy after radical surgery for high-grade and high-stage urothelial cancer.

[A case of malignant Sertoli cell tumor of the testis]

A 74-year-old man consulted our hospital about a painless swelling of the right scrotal contents. Laboratory findings showed no abnormalities. A right high orchiectomy was performed. The tumor measured 4.2 X 6.0 cm in size and was yellow-white in color. Histologically, the tumor was diagnosed as a malignant Sertoli cell tumor on the basis of findings of invasion and a high mitosis rate. Combined chemotherapy was performed after the operation and no recurrence was found. The Sertoli cell tumor of the testis is a rare neoplasm, and its malignant type is extremely rare. In Japan, 7 cases have been reported, and only 2 of them have been malignant. This case is the 3rd instance malignant Sertoli cell tumor in this country.

[Primary malignant melanoma of the female urethra: a case report]

A 76-year-old woman visited us with the chief complaint of a urethral mass on September 11, 1984. There was a thumb-sized, brownish and painless mass in the posterior wall of the urethra. Although excretory urogram revealed nothing remarkable, CT scan suggested metastasis of retroperitoneal lymph nodes. Biopsy of the urethral mass revealed malignant melanoma. She was treated with combined chemotherapy of dimethyltriazenoimidazole carboxamide, peplomycin, and cis-diamine-dichloride platinum, but died of respiratory insufficiency on January 6, 1985. Thirteen cases of primary malignant melanoma of the female urethra, including our own, have been reported in the Japanese literature.

[Clinical study of testicular tumors (59 cases in Sakai Municipal Hospital)]

Fifty-nine cases of testicular cancers were admitted to our hospital between 1960 and 1984. Thirty cases were seminoma (patients aged 12-64 years) and 29 cases were non-seminoma (6 patients were 1-7 years old and 23 were 17-44 years old). One of each of the seminoma and non-seminoma cases was not included in our analysis due to death before sufficient treatment. Of the remaining 29 cases of seminoma, 24 were in stage I, 4 in stage II, and 1 was in stage III. Of the remaining 22 adult cases of non-seminoma, 15 were in stage I, 2 in stage II, and 5 in stage III. Most of the cases with seminoma were treated with radiation after orchiectomy. Two of the cases of advanced seminoma and all of the cases of non-seminoma without mature teratoma were treated with retroperitoneal lymphadenectomy and/or chemotherapy after orchiectomy. Of the seminoma cases, only one patient (stage II cancer) died. On the other hand, only one of the non-seminoma patients in stages II and III remained alive. Since 1979, 5 patients with stage III or bulky stage II disease have been treated with the PVB protocol and 4 were evaluable. Only one patient achieved complete remission (CR) but he suffered a relapse within a short period (4 months). Three patients were partial responders and two of them achieved CR following resection of residual disease and additional VAB-6 induction. Currently, none of the patients who were treated with the initial PVB protocol alone remain in CR.

Changes in Protein Composition and Mn Abundance in Photosystem II Particles on Photoactivation of the Latent O(2)-Evolving System in Flash-Grown Wheat Leaves

Protein composition and Mn abundance were compared between the two photosystem II (PSII) particle preparations obtained before and after photoactivation of the latent O(2)-evolving system in intermittently flashed wheat leaves. The following results have been obtained: (a) nonphotoactivated PSII particles were devoid of two extrinsic proteins which corresponded to the 24 and 16 kilodalton proteins in spinach particles, although the particles contained all the intrinsic proteins and the 33 kilodalton extrinsic protein. (b) The two extrinsic proteins absent in nonphotoactivated PSII particles were present in nonphotoactivated thylakoids, but were easily removed by a hypotonic shock followed by brief sonication. Such removal of the proteins did not occur in photoactivated thylakoids. (c) Nonphotoactivated PSII particles contained 1.5 Mn/400 chlorophyll, while photoactivated particles contained 8 Mn/400 chlorophyll. (d) Nonphotoactivated thylakoids contained 6 Mn/400 chlorophyll, but most of them were removed from thylakoids by a hypotonic shock in the presence of ethylenediaminetetraacetate. Such removal of Mn did not occur in photoactivated thylakoids.

[Ectopic ureteral opening in four males: including a case of inverted Y ureteral duplication]

Four males with ectopic ureteral opening are reported herein. Case 1 was a 17 year old who complained of miction pain and macroscopic hematuria. Cystoscopy and radiological examinations showed left ectopic ureteral opening into the seminal vesicle associated with left renal agenesis. The left ureter and seminal vesicle were extirpated. Case 2 was a 21 year old who complained of lower abdominal pain. On physical examination, a child's head sized mass was palpable in the midline of the lower abdomen. Operation was performed under diagnosis of intrapelvic tumor, but the mass was cystic dilatation of left ureter which opened into the seminal vesicle. Case 3 was a 19 year old who complained of right CVA colic pain. On cystoscopy, the right ureteral orifice was absent. During the operation, right ureter was found to open into the posterior urethra. Case 4 was a 57 year old who complained of fever. Plain X-ray on the pelvic cavity showed a 82 X 10 mm calcified shadow. CT revealed a right ectopic ureteral opening into the posterior urethra with a ureteral stone in it. On cystoscopy, the right ureteral orifice was identified and pus discharge was observed to flow out of it. Operative exploration demonstrated that the right ureter was inverted Y duplication; one opened into the posterior urethra and the other into the trigone. Seventy nine males with ectopic ureteral opening and 3 with inverted Y ureteral duplication from the Japanese literature are reviewed briefly.

Masculinizing operation for a female patient with congenital adrenocortical hyperplasia due to 21-hydroxylase deficiency

A 25-year-old female with simple virilizing type of congenital adrenocortical hyperplasia due to 21-hydroxylase deficiency was treated surgically with masculinizing operations which consisted of two-stage procedures. The first procedure was chordectomy associated with excision of both gonads and female internal genitalia. Eleven months later, the second procedure consisting of urethroplasty and implantation of testicular prosthesis was performed. The postoperative course was successful in terms of urination and penile erection.