Fibrinogen γ-chain peptide-coated, ADP-encapsulated liposomes rescue thrombocytopenic rabbits from non-compressible liver hemorrhage

BACKGROUND

We developed a fibrinogen γ-chain (dodecapeptide HHLGGAKQAGDV [H12])-coated, ADP-encapsulated liposome (H12-[ADP]-liposome) that accumulates at bleeding sites via interaction with activated platelets via glycoprotein IIb-IIIa and augments platelet aggregation by releasing ADP.

OBJECTIVE

To evaluate the efficacy of H12-(ADP)-liposomes for treating liver hemorrhage in rabbits with acute thrombocytopenia.

METHODS

Thrombocytopenia (platelets < 50 000 μL(-1)) was induced in rabbits by repeated blood withdrawal (100 mL kg(-1) in total) and isovolemic transfusion of autologous washed red blood cells. H12-(ADP)-liposomes with platelet-poor plasma (PPP), platelet-rich plasma (PRP), PPP, ADP liposomes with PPP or H12-(PBS)-liposomes/PPP, were administered to the thrombocytopenic rabbits, and liver hemorrhage was induced by penetrating liver injury.

RESULTS

Administration of H12-(ADP)-liposomes and of PRP rescued all thrombocytopenic rabbits from liver hemorrhage as a result of potent hemostasis at the liver bleeding site, although rabbits receiving PPP or ADP liposomes showed 20% survival in the first 24 h. Administration of H12-(ADP)-liposomes and of PRP suppressed both bleeding volume and time from the site of liver injury. H12-(phosphate-buffered saline)-liposomes lacking ADP also improved rabbit survival after liver hemorrhage, although their hemostatic effect was weaker. In rabbits with severe thrombocytopenia (25 000 platelets μL(-1)), the hemostatic effects of H12-(ADP)-liposomes tended to be attenuated as compared with those of PRP treatment. Histologic examination revealed that H12-(ADP)-liposomes accumulated at the bleeding site in the liver. Notably, neither macrothombi nor microthrombi were detected in the lung, kidney or liver in rabbits treated with H12-(ADP)-liposomes.

CONCLUSIONS

H12-(ADP)-liposomes appear to be a safe and effective therapeutic tool for acute thrombocytopenic trauma patients with massive bleeding.

Prognostic factors of clear renal cell carcinoma in pT1a cases

e16064

Background: The proportion of clear cell renal cell carcinoma (CRCC) cases diagnosed at pT1a is known to be increasing significantly. Although their prognosis is excellent in general, some cases show distant metastasis. Most of proposed prognostic factors are based on mainly large sized CRCC data. The prognostic factors for small sized CRCC, especially for pT1a cases, aren't well described. Methods: Three hundred three pT1a CRCC cases were retrieved from authors’ institution files. All cases were reviewed by the single uropathologist (T. Tsuzuki). For each case, the following pathological parameters were analyzed: patient age, tumor location (upper, middle, low), Furhman grade, presence of capsule, presence of lympho-vascular invasion, growth pattern (expansive or infiltrating), presence of scar, presence of hemorrhage, and presence of necrosis. Results: Male to female ratio was 4.4. Patient's age ranged from 21 to 85 years (median: 59 years). Follow up duration ranged from one to 225 months (median: 59 months). 35 cases showed distant metastasis. The 5-year and 10-year cause specific survival rate were 96.9%, 93.0%. The 5-year and 10-year recurrence free survival rate were 91.8%, 83.9%. Furhman grade (grade 1+2+3 vs. 4), presence of lympho-vascular invasion, infiltrating growth pattern, and presence of necrosis were statistical significant (p < 0.0001). Conclusions: Furhman grade (less than 3 vs. 4), presence of lympho-vascular invasion, growth pattern, and presence of necrosis can be prognostic factors in CRCC in pTa cases. Growth pattern, which is unrecognized concept for prognosis, can be a new prognostic factor in CRCC.

No significant financial relationships to disclose.

Gait initiation in bilateral vestibular loss

OBJECTIVE

Gait initiation is a transient procedure between orthostatic posture and steady-state locomotion and includes anticipatory anteroposterior (AP) and lateral movements. Commands for this task are located in some levels of brain stem, which modulates activity of central pattern generator in the spinal cord. The purpose of this work was to explore the role of the vestibular system in this voluntary stepping.

METHODS

Six patients with chronic bilateral vestibular loss (BVL) were measured by means of a large force plate (70 cm x 120 cm ) and the displacement of the center of pressure (COP) during gait initiation was calculated. Measurement parameters comprised maximum distance (MD), velocity (MV) in the AP and lateral direction as well as for pre-, first- and second-step stages, and the angle of the COP trajectory.

RESULTS

For all stages, BVL patients registered lower values for both MD and MV in the AP direction than did normal subjects. In the lateral direction, however, neither MD nor MV in BVL patients showed any difference from those of normals. The step angle of the COP trajectory was obviously reduced.

CONCLUSION

These results suggest that in the AP direction, the vestibulospinal pathway can influence the locomotor related neural circuits, including the central pattern generator and supraspinal levels, by means of modifying the velocity and step length in order to stabilize the trunk. On the other hand, the control mechanism in the lateral direction may be different from that in the AP direction.

[Retropubic radical prostatectomy with the use of ultrasonic cutting and coagulating system (AutoSonix System)]

We report our experience of using the ultrasonic coagulating and cutting device, AutoSonix System, which began in January 2000 to reduce the amount of bleeding in radical retropubic prostatectomy. The mean age of the 24 prostate cancer patients operated on was 68.2 years old. The operation results were excellent; the mean operation time was 227 +/- 29 minutes (mean +/- standard deviation), and the mean amount of blood loss during the operation was 215 +/- 114 ml. There were no major complications. After three months or more of follow-up, no patients needed any pads for urinary incontinence. Only one case showed a stricture at cystourethral anastomosis. AutoSonix System was useful to reduce the blood loss from the venous plexus in the pelvic cavity. We believe that radical prostatectomy would be safer if this device would be used by the urologist.

Direct screening of the IMP-1 metallo-beta-lactamase gene (blaIMP) from urine samples by polymerase chain reaction

BACKGROUND

As Gram-negative bacterial isolates producing plasmid-mediated IMP-1 metallo-beta-lactamase usually demonstrate resistance to various broad-spectrum beta-lactams, including cephamycins and carbapenems, transmission and proliferation of these microorganisms in clinical settings could become a clinical threat in the near future. According to previous studies by the same authors, IMP-1-producing strains are usually isolated from urine samples. Therefore, in this study, a polymerase chain reaction (PCR) was applied for direct screening of the IMP-1 metallo-beta-lactamase gene in urine samples.

METHOD

Urine samples were collected from 273 inpatients to whom various broad-spectrum beta-lactams, including carbapenems, had been administered in 57 hospitals in 1997. DNA templates for PCR analyses were prepared directly from 19 urine samples from which Serratia marcescens strains demonstrating high-level resistance (minimal inhibitory concentration > 128 microg/mL) to both ceftazidime and cefoperazone-sulbactam were later isolated.

RESULTS

The IMP-1 metallo-beta-lactamase gene (blaIMP)-specific 578 bp fragments were able to be amplified successfully in eight of the 19 samples. In the seven strains isolated from the eight samples, the presence of blaIMP was also detected by a DNA hybridization analysis. The lower limit of the PCR method was determined as 1 x 10(2) CFU of blaIMP-bearing bacterial cells per 1 mL of urine sample. No false positive result was found.

CONCLUSION

The PCR-aided direct screening of blaIMP is applicable to early recognition of IMP-1-producing bacteria in urine samples. This method would help to prevent nosocomial and interhospital transmission of this kind of hazardous bacteria, as well as the advancement of rigorous infection control.

Two-dimensional alterations of myenteric plexus in jejunoileal atresia

PURPOSE

The purpose of this report is to investigate changes in the myenteric plexus associated with the dilated proximal segment of jejunoileal atresia (JA). Two-dimensional morphologic changes in the myenteric nerve plexuses were investigated using whole-mount preparation.

METHODS

Proximal (P) and distal (D) intestinal segments from 7 cases with JA and control (C) segments from 5 postmortem neonates were investigated. The circumference of the jejunoileal segments was measured after fixation. Antibodies for protein gene product 9.5 and neurofilament protein were used in whole-mount preparation. The sizes of neural networks were calculated by measuring the longest circular distance in a neural network (x) and the longest longitudinal distance (y), and the width of the internodal strands (i) with a videomicrometer.

RESULTS

Median circumference of the segments was 8.5 in P, 2.0 in D, and 2.0 cm in C. The neural networks in P were expanded longitudinally as well as circularly (x = 817.10 microm, y = 561.26, i = 31.04: median) while comparing them to those in D (x = 431.40 microm y = 288.07, i = 26.05) or C (x = 285.03 microm y = 372.20, c = 1113.57, i = 32.39). The nerve plexus was less expanded than the intestinal wall.

CONCLUSIONS

Proximal intestinal segments showed a restructuring that resulted in mild hypoplasia of the enteric nerve plexuses in the proximal segments. The less expansion of the myenteric nerve plexus seen in the proximal bowel in infants with JA suggests a histologic basis for the efficacy of tapering or plication of the dilated bowel.

Is carotid reconstruction for advanced cancer in the neck a safe procedure?

Head and neck surgeons hesitate to resect the carotid artery because of the postoperative risk of neurologic sequelae. On the other hand, there is no curative therapeutic option for head and neck cancer involving the carotid artery, except for complete tumor removal. A retrospective review of all published articles in the English literature dealing with carotid reconstruction for head and neck cancer from 1987 to 1998 was performed. There were only 11 articles, including our series, that reported outcomes of this procedure. Among the 148 patients of this series, major neuromorbidity was 4.7%, and mortality occurred in 6.8% of the patients. Combined major neuromorbidity and mortality was 10.1%. Because total removal of the advanced cancer is the only therapy that can offer the patients a chance for cure, head and neck surgeons should aggressively perform carotid resection and reconstruction.

Microsurgical vasoepididymostomy with sperm cryopreservation for future assisted reproduction

BACKGROUND

Although obstructive azoospermia is treatable with microscopic seminal reconstruction, the number of patients who choose to undergo vasoepididymostomy is limited because of recent advances in assisted reproductive technology (ART). We attempted to define the outcome of surgical reconstruction in patients with suspected epididymal obstruction and no previous history of vasectomy.

METHODS

We described 40 eligible end-to-side vasoepididymostomy procedures performed on 24 azoospermic patients who had either bilateral or unilateral epididymal obstruction.

RESULTS

The overall patency rate following surgery was 54% (13/24) and for four patients (17%), natural intercourse resulted in pregnancy. Two pregnancies were initiated with intracytoplasmic sperm injections using frozen sperm collected during vasoepididymostomy.

CONCLUSIONS

In the era of modern ART, microsurgical vasoepididymostomy with cryopreservation of sperm collected during the operation is recommended for patients with epididymal obstructions.

The effects of intense click sounds on velocity storage in optokinetic after-nystagmus

Vestibular evoked myogenic potentials (VEMP) occurring after click stimulation in cervical muscles are thought to be a polysynaptic response of otolith-vestibular nerve origin. In optokinetic after-nystagmus (OKAN) the direction of after-nystagmus changes and slow-phase velocity decreases with head tilt. This phenomenon may be an otolith response to the direction of gravity. We assumed that intense clicks might have some influence on OKAN via the otolith-vestibular nerve. Twelve normal subjects who showed VEMP at 75 dB normal hearing level (nHL) clicks were examined. The OKAN was recorded under four conditions: right monaural, left monaural and binaural stimulation by 75 dB nHL clicks, and absence of click stimulation. Horizontal optokinetic stimulation was applied using stepwise increasing speeds from 30 deg/s to 90 deg/s. Two seconds before the stimulus ended, clicks were sounded. The slow-phase velocity of the recorded electro-nystagmography was manually measured. There was no effect on OKAN with unilateral stimulation but binaural stimulation suppressed it. These results suggest that a velocity storage integrator is influenced by intense clicks via the otolithic area.

Chemical constituents of Clausena excavata: isolation and structure elucidation of novel furanone-coumarins with inhibitory effects for tumor-promotion

A study of the chemical constituents of the leaves of Clausena excavata cultivated in a greenhouse led to the isolation and identification of 10 new furanone-coumarins named clauslactones A (1), B (2), C (3), D (4), E (5), F (6), G (7), H (8), I (9), and J (10), together with a known carbazole, clauszoline M, and a coumarin, umbelliferone. The new coumarins contain a C(10) terpenoid side chain with a furanone (gamma-lactone) moiety. Further, in clauslactones A-D (1-4), the terpenoid side chain was shown to be linked to the 7,8-dioxygenated coumarin skeleton through a 1, 4-dioxane ring system. This is the first example of coumarins with these structural characteristics in nature. These furanone-coumarins were found to exhibit inhibitory activity against 12-O-tetradecanoylphorbol-13-acetate-induced Epstein-Barr virus early antigen activation in Raji cells.

Chemical constituents of Avicennia alba. Isolation and structural elucidation of new naphthoquinones and their analogues

Three new naphthoquinones and their analogues, named avicequinone-A (1), -B (2), -C (3), and avicenol-A (4), -B (5), -C (6), respectively, were isolated from the stem bark of Avicennia alba (Avicenniaceae) collected in Singapore, and their structures were elucidated by means of spectral methods. Gillan and co-workers have proposed that the structures of the new phytoalexins isolated from Avicennia marina are 1,2-naphthoquinones 8 and 9. Our synthetic and spectrometric studies showed that these structures should be revised respectively to 1,4-naphthoquinones 2 and 3, named avicequinone-B and -C by us.

Bilateral basal-cell adenomas in the parotid glands

A rare case of bilateral basal-cell adenomas in the parotid glands of a 65-year-old woman is reported. There have been only four previous reported cases of bilateral parotid basal-cell adenomas, all of which occurred synchronously with dermal cylindromas. The present lesion is the first case reported in the English literature of bilateral parotid basal-cell adenoma without coexisting dermal cylindroma. Histological examination revealed that the left tumour had adenoid cystic change, which closely resembled adenoid cystic carcinoma. This case is of interest not only because of the raity of bilateral parotid basal-cell adenomas, but also because of the necessity for differentiation from adenoid cystic carcinoma in order to plan appropriate treatment.

New carbazole alkaloids from Clausena anisata with antitumor promoting activity

Four new carbazole alkaloids, named clausamine D (1), E (2), F (3), and G (4), were isolated from Clausena anisata as inhibitors of Epstein-Barr virus early antigen activation induced by 12-O-tetradecanoylphorbol-13-acetate in Raji cells.

Excision of cervical cystic lymphangioma using injection of hydrocolloid dental impression material. A technical case report

A lymphangioma, arising in an adult patient, was completely removed after injection of hydrocolloid dental impression material. The postoperative course was uneventful, with no sign of foreign-body reaction. The agar impression material, which had excellent tractability during operation, may be used as a filling material, as long as preoperative examinations show that the tumor does not involve major vessels or nerves.

Possible factors affecting response to intravesical bacillus Calmette-Guérin (Tokyo 172 strain) therapy for carcinoma in situ of the bladder: a multivariate analysis

To evaluate clinicopathological factors affecting response to intravesical instillation therapy with the bacillus Calmette-Guérin (BCG) Tokyo 172 strain for carcinoma in situ (CIS) of the bladder, we reviewed data for 84 patients treated between 1985 and 1996. Median follow-up was 56 months. The patients comprised three groups: primary (only the in situ lesion, 31 patients), subsequent (found after treatment of a gross neoplasm, 20), and concomitant (found together with a gross neoplasm, 33). A complete response was found in 62 (74%) of the 84 patients. Intravesical BCG therapy eradicated tumour cells in 74% of the primary group, 70% of the subsequent group, and 76% of the concomitant group. Multivariate logistic regression analysis revealed that the presence of gross haematuria and patient age were significantly associated with a complete response to the intravesical BCG therapy (p<0.05). On the other hand, gender, irritative bladder symptoms, type of extent of CIS, histological grade of CIS, BCG dose, and number of times BCG was given did not exert any significant influence. The 5-year recurrence rate was 33% for the 62 patients for whom a complete response was once achieved. Patients aged 60 or older had a higher probability of recurrence than those less than 60 years of age (p<0.05). Disease progression was found in 13% of the 84 patients and total cystectomy was performed in 19%. The present finding that patient age is related to the response to intravesical BCG therapy may point to a role for the reduced host immunocompetence in elderly individuals.

Different concentrations of two small stress proteins, alphaB crystallin and HSP27 in human urological tumor tissues

Concentrations of two small stress proteins, alphaB crystallin and the 27-kDa heat shock protein (HSP27) were quantitated in tissues of the human normal genitourinary system and their tumors. Levels of HSP27 in renal cell carcinomas (mean +/- SE: 1450+/-262 ng/mg protein, n = 15) were significantly higher than in normal kidney (the cortex: 540+/-99 ng/ mg protein, n = 13; the medulla: 600+/-106 ng/mg protein, n = 13) while those of alphaB crystallin tended to be increased without statistical significance. These findings were similar to those previously reported for renal cell tumors chemically induced in rats. Concentrations of alphaB crystallin in prostatic carcinoma tissues (410+/-129 ng/mg protein, n = 10) were also significantly higher than in benign prostatic hyperplasia (54+/-12 ng/mg protein, n = 14), whereas alphaB crystallin levels in testicular tumors including seminomas (2.1+/-0.8 ng/mg protein, n = 11) and non-seminomas (5.2+/-2.3 ng/mg protein, n = 9) were significantly lower than in normal testicular tissues (29.7+/-6.2 ng/mg protein, n = 5). Both alphaB crystallin and HSP27 could be immunohistochemically localized in the normal kidney and renal cell carcinoma tissues.

Carotid resection and reconstruction for advanced cervical cancer

Patients with advanced cervical cancers often have direct invasion of their carotid arteries. The prognosis for these patients with nonsurgical therapy is extremely poor. Because complete tumor removal is the only therapy that can offer these patients a chance for cure, carotid resection should be performed. We performed carotid resection and reconstruction on nine patients with advanced cervical cancers. Of these patients, none suffered from severe neurologic postoperative complications such as permanent hemiplegia. Three of the nine patients have been disease free for more than 24 months. These three patients would not have survived without carotid resection. Further study will show the usefulness of carotid resection and reconstruction in decreasing the morbidity and mortality in patients with cervical cancer involving the carotid artery.

Characterization and management of deep neck infections

A retrospective review was conducted of 91 patients with deep neck infections to determine the pattern of clinical disease and formulate a management plan. The spaces involved, as determined by clinical, radiologic, and operative findings, were the peritonsillar space (72 patients), parapharyngeal space (eight patients) submandibular space (seven patients), retropharyngeal space (one patient) superficial space (one patient), anterior visceral space (one patient), and visceral vascular space (one patient). Of the 19 patients who did not have a peritonsillar space infection the origin of the infection was found in eight; four of these were odontogenic. Thirty-eight patients required surgical drainage of the abscess. Five patients underwent tracheotomy due to increasing dyspnea. One patient with diabetes mellitus and a past history of myocardial infarction died of unknown cause. All other patients had an uneventful recovery without major complications. The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.

Surgical outcome of microscopic vasectomy reversal: an analysis of 30 cases

The results of 30 consecutive microscopic vasovasostomy procedures performed at a single institution over a five-year period between 1991 and 1995 were reviewed. When the surgical outcomes of patients who were operated on less than five years after their vasectomy were compared with the outcomes of those patients who received a vasovasostomy more than five years after their vasectomy, decreases in technical success rates were observed as measured by appearance of sperm in ejaculate (56% vs. 36%), biologic recovery as measured by mean sperm counts (56 million vs. 35 million) and mean progressive sperm motility (44% vs. 21%), along with a decrease in clinical success, as measured by overall pregnancy rates (50% vs. 7%, p < 0.05). Therefore, a microscopic vasovasostomy within 5 years of a vasectomy is a favorable procedure for vasectomy reversal.

Vestibulo-ocular reflex and visual vestibulo-ocular reflex during sinusoidal rotation in children

To clarify the relationship between vestibular and visual (optokinetic) stimuli in normal children, we investigated the vestibulo-ocular reflex (VOR) and visual VOR (VVOR). The subjects were 20 healthy children aged 3-6 years and 24 healthy adults aged 21-29 years. The VOR gains and phase were measured under two visual conditions: with eyes open in complete darkness and with eyes open in a lighted optokinetic drum. In both visual conditions, phase did not significantly differ between children and adults. In the dark, children presented a significantly larger gain than that of adults. In the optokinetic drum, however, the gain values of the children were almost the same as in adults. We suggest that the large VOR gain values of children may be due to immaturity of the inhibitory regulation system of the VOR.

Two cases of intrascrotal liposarcoma

Liposarcomas in the scrotum are relatively rare and only 40 cases have previously been reported in Japan. The inside wall of the scrotum is an unusual origin and we report here two cases arising at this site that have been followed for 21 and 40 months, respectively, after surgical resection. Case 1: the patient was a 24-year-old male who noticed a left intrascrotal mass which was histologically demonstrated to be a myxoid type liposarcoma. Case 2: the patient was a 66-year-old male who had the complaint of a left intrascrotal swelling. He underwent radical orchiectomy and histologic examination of the resected tumor revealed a well-differentiated type of liposarcoma. These two cases are the 41st and 42nd intrascrotal liposarcomas reported in Japan.

Effects of varicocelectomy on testis volume and semen parameters in adolescents: a randomized prospective study

Because the treatment of a varicocele in adolescents remains controversial, we undertook a prospective study in 51 male adolescents, aged 15-21 years, who were referred for a varicocele. Twenty-nine patients were treated with high retroperitoneal ligation of the left spermatic vein, and 22 were untreated. Eighteen healthy adolescent volunteers without a varicocele were also assessed. Testicular volume was measured using an orchiometer, and semen analyses were carried out at referral and after 1 year of follow-up. In addition, serum luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels were estimated by radioimmunoassay. Both patient groups had significantly smaller testis volumes than the controls at the outset. In the follow-up, the treated patients had testis volumes similar to those of the controls. Both testes increased significantly in volume after treatment. Although semen parameters were comparable in all groups initially, sperm concentration increased significantly after treatment of the varicocele. We concluded that varicocele treatment in adolescents leads to increased testis volume and a higher sperm concentration; however, whether early treatment will improve testicular function remains to be elucidated.

A case of sex reversal syndrome with sex-determining region (XX male)

We examined a 32-year-old man with a 4-year history of infertility. The man's sex life, male hair pattern, and penis were normal, and he had no history of erection problems. Left and right testicular volumes were 2 ml and 3 ml, respectively. Semen analysis showed no sperm. The endocrine panel revealed increased serum luteinizing hormone and follicle-stimulating hormone levels, and a normal serum testosterone level. A testicular biopsy demonstrated that both Leydig cell and Sertoli cell hyperplasia were present, and that no germ cells were found in the tubules. A chromosome analysis done on the peripheral blood lymphocytes revealed a karyotype of 46, XX. We identified the sex-determining region, Y, by polymerase chain reaction using Y-specific probes in this patient. The diagnosis was XX male.

[One stage ipsilateral vascular reconstruction of the carotid artery--distal or proximal limits at cervical operation]

Since 1990, in treating 10 cases with head and neck tumors which had invaded the carotid artery, the authors have performed vascular reconstruction of the carotid artery. The standard surgical procedure is en bloc resection of the tumor and carotid artery and one stage ipsilateral vascular reconstruction of the carotid artery at cervical operation using a temporary shunt tube. When the tumor is located in a distal or proximal cervical portion, craniotomy or thoracotomy is needed in addition to the usual surgical procedure. The author classifies one stage ipsilateral reconstruction of the carotid artery into four types, depending on the anastomotic site, and describes distal or proximal limits of this procedure at cervical operation. Type A: Cervical operation after partial resection of the carotid wall; Patch angioplasty or simple arteriorrhaphy. Type B: Cervical operation after round resection of the carotid wall; Common carotid-internal carotid artery graft interposition, etc. Type C: Using craniotomy in addition to the cervical operation; Common carotid-middle cerebral artery bypass, etc. Type D: Using thoracotomy in addition to the cervical operation; Transthoracic subclavian-internal carotid artery bypass, etc. The design of the operative technique and adjunct enable distal or proximal limits of this procedure to be expanded. It is necessary to discuss the limits of this procedure in each case. Selecting an adequate surgical procedure based on intraoperative findings requires close teamwork with neurosurgeons and thoracic surgeons.

Human chorionic gonadotropin adjuvant therapy for patients with Leydig cell dysfunction after varicocelectomy

The authors treated 135 men who underwent varicocelectomy, but had sustained Leydig cell dysfunction disclosed by LHRH test with human chorionic gonadotropin (hCG). hCG was administered for 10 weeks: 50,000 units were given in 10 divided doses intramuscularly. Semen analysis and measurement of serum hormone level were obtained 8 weeks after the completion of treatment, and every 3 months after that. All patients were followed up for 2 years to confirm pregnancy. Fifty-five percent of patients achieved pregnancy and they showed significant increase in sperm density, percentage of sperm motility, normal form sperm, and serum testosterone level. It is recommended that hCG be administered to patients who undergo varicocelectomy but have persistent subtle Leydig cell dysfunction disclosed by LHRH test to stimulate the intratesticular testosterone production.

[Clinical evaluation of a new polymerase chain reaction assay for detection of Chlamydia trachomatis in young patients with acute epididymitis]

Specimens from 15 young patients presenting with acute epididymitis were tested for the presence of Chlamydia trachomatis by an enzyme immunoassay (EIA), polymerase chain reaction (PCR), and for other bacteria by standard laboratory techniques. C. trachomatis urethral infection was detected in 3 patients by an EIA test of the urethral swabs (20%) and in 13 patients by the PCR (87%). This difference in detection rate was statistically significant (p < 0.005). Thirteen specimens were positive by the PCR, but only three of them were positive by the EIA method. These findings indicate that the PCR assay is a highly sensitive assay for the detection of C. trachomatis in male urine specimens and provides a noninvasive technique for routine screening of chlamydia infection in the patient with acute epididymitis.

[Vascular reconstruction of the carotid artery--studies of a one stage ipsilateral reconstructive procedure]

Recent advance in vascular surgery have made vascular reconstruction of the carotid artery possible. Since 1990, the authors have performed en bloc resection of the carotid artery and vascular reconstruction of the carotid artery, using a temporary shunt tube, in 10 cases. Among these 10 cases of tumors involving the carotid artery, two cases had carotid body tumors and the other eight cases had metastatic lymph nodes from head and neck cancers. Transient motor paralysis occurred in three cases and disorientation in one after the operation. None has developed severe neurological complications such as death, coma or permanent hemiplegia. Despite preoperative irradiation, local infection was noted in only one case after the operation. Rupture of the vein graft was prevented by using a DP flap to cover dead space at the anastomotic site. The two patients with a carotid body tumor are alive without evidence of recurrence. Among eight patients with cancer, three are still alive and disease free (respectively 44, 30 and 16 months). Two patients died of local recurrence, two of distant metastasis and the other of acute heart failure. Local tumor control was possible in six out of eight patients. We were able to safely perform en bloc resection of the carotid artery and vascular reconstruction of the carotid artery using a temporary shunt tube. In conclusion, we anticipate increasing curability of advanced tumors involving the carotid artery using this procedure.

Serum inhibin levels in normal men and men with idiopathic infertility

In vitro studies have shown that the Sertoli cell is the primary source of inhibin in the male. To assess the regulation of inhibin production we measured serum inhibin, FSH, LH and testosterone in 21 normal men and 104 men with various testicular disorders resulting in infertility. The infertile men were subdivided into groups on the basis of their mean sperm count, FSH and LH levels. The mean serum concentrations of inhibin in the normal men were 602 +/- 29 U/L and were significantly decreased in those groups with severe oligozoospermia (p < 0.01) or azoospermia (p < 0.01; p < 0.001). The FSH concentrations correlated inversely with serum inhibin concentrations (p < 0.001) in azoospermic men. Azoospermic men with high FSH had significantly lower inhibin and testosterone levels when compared with normal men (p < 0.01; p < 0.001). Serum FSH concentrations were significantly increased in azoospermic men (p < 0.001). Our present results of serum concentrations of inhibin correlating inversely with those of FSH levels suggest that measurement of inhibin may be a useful circulating marker of Sertoli cell function.

Serum estradiol levels in normal men and men with idiopathic infertility

Serum estradiol levels were measured in 360 men attending an infertility clinic and 68 proven fertile men to determine whether estradiol measurements are clinically useful. The normal range of estradiol levels found in fertile men was 10-82 pg/ml. Serum concentrations of estradiol in azoospermic or oligozoospermic patients were significantly lower than those in normozoospermic men (p < 0.021). Serum concentrations of testosterone were also significantly decreased in infertile patients (p < 0.025). This decrease in serum estradiol may be partly due to reduced testosterone levels in these men because estradiol is mainly formed by peripheral aromatization of testosterone in fatty and muscle tissues. However, the exact mechanism for the decrease in the serum estradiol levels remains undetermined. It is concluded that serum estradiol levels are significantly low in the men with various testicular disorders.

Management of chronic orchialgia of unknown etiology

The treatment of patients with chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain of greater than 3 months and of unclear cause, is difficult. This pain significantly interferes with the daily activities of the patient. We have seen 12 patients with chronic orchialgia of unknown etiology and each had a normal history, physical examination and normal scrotal sonogram. Three patients were treated with nonsteroidal anti-inflammatory drugs and obtained partial pain relief. Three patients underwent spermatic cord nerve blockade using a combination of 1% lidocaine and 40 mg methylprednisolone and experienced partial pain relief. Four patients underwent inguinal orchiectomy after failing conservative management: three reported complete relief of pain, and the other partial relief. Two patients had bilateral transrectal injections of local anesthetic (5 ml bupivacaine) and methylprednisolone into the region of the pelvic plexus under transrectal ultrasound guidance. They were successfully treated with this injection technique. On the basis of our results, we recommend transrectal blockade of nerves from the pelvic plexus or inguinal orchiectomy as the procedure of choice for patients in whom medical treatment fails.

The effect of varicocelectomy on testicular volume in infertile patients with varicoceles

The presence of a varicocele has been associated with decrease in testicular volume both in adult and pediatric patients. However, a study on the effect of varicocelectomy on testicular volume in the adult varicocele patient has never been reported. We determined the testicular volume before and after varicocelectomy in 52 patients with varicocele. A significant increase in testicular volume with the right side showing a greater increase was observed (p < 0.05). No greater increase in testicular volume was noted among the patients who achieved a pregnancy with their spouses. In addition, the age of the patient did not correlate with the observed change in testicular volume. These results suggest that varicocele is clearly related to decreased testicular volume and that varicocelectomy can increase bilateral testis volume resulting in improved testicular function.

Antibiotic and ejaculation treatments improve resolution rate of leukocytospermia in infertile men with prostatitis

Leukocytospermia has been associated with notable adverse effects on semen parameters and sperm function. The present study was undertaken to identify men with leukocytospermia and prostatitis in an infertility population and assess the effects of various treatments. One million white blood cells (WBC)/ml semen was defined as leukocytospermia. An expressed prostatic fluid was analyzed for the presence of white blood cells. The presence of more than 10 WBCs/high power field on expressed prostatic secretion was needed for the diagnosis of prostatitis. Those men who had more than one million WBCs in their semen and more than 10 WBCs/high power field on expressed prostatic secretion were enrolled in this study. Of two hundred sixty-three men screened for the presence of leukocytospermia and prostatitis, forty-eight men met both criteria. They were blindly and randomly assigned to one of three groups. Group 1 received no treatment. Group 2 were treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX) orally twice per day for one month. Group 3 were treated not only with the same antibiotic regimen as group 2 but also were instructed to ejaculate frequently (at least once every three days) for one month. Significant resolution of leukocytospermia occurred in the order of patient groups 3 > 2 > 1 at one month. The resolution rate of leukocytospermia of each group was 76% in group 3, 56% in group 2 and 6.7% in group 1. The rates in groups 2 and 3 were significantly higher than that in group 1 (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Successful in vitro fertilization and pregnancy by the micromanipulation with sperm from efferent duct retrieved by micropuncture technique in a patient with congenital absence of the vas deferens

A case of successful in vitro microfertilization and pregnancy of 30-year-old woman with sperm from efferent duct retrieved by a micropuncture technique combined with perivascular nerve stimulation from a patient with congenital absence of the vas deferens is reported. Treatment of couples involving men with surgically unreconstructible vasal obstruction is now possible. Our experience indicates that sperm from the efferent duct retrieved by this new technique, when combined with assisted reproductive technologies, permit fertilization and subsequent pregnancy for the men with surgically irreparable vasal obstruction.

Changes with aging in head and center of foot pressure sway in children

To quantitate the development of equilibrium in children, we investigated movements of the head and of the center of foot pressure (COF) in standing subjects, using a cephalograph, a force measuring platform, and a technical computer. We studied 126 subjects, 105 healthy children, aged 4-18 years, and 21 adults, aged 20-28 years. Each subject stood with their feet together on a platform for 60 s each with eyes open or closed. The area and total length of head and COF movements decreased with increasing age, and were significantly greater in children under 12 years than in adults. The ratio of the lengths of head to COF movements was significantly larger in children under 9 years than in adults. The ratio of the anteroposterior to lateral movement of COF was also larger in children under 9 years. These observations suggested that body sway in children was not only larger than that in adults, but different in nature.

Tympanometric changes following acute otitis media in Japanese children

Using tympanometry we investigated potential changes in both middle ears developing during and after unilateral acute otitis media (AOM) in Japanese children. In 144 children with unilateral (AOM), tympanometry was performed at presentation and was repeated at the 1st, 2nd, 3rd, and 4th weeks and then every 2 weeks up to 12 weeks after entry into the study. Type B tympanograms were recorded in 81 (56%) of the affected ears and in 37 (26%) of the unaffected ears at presentation. Twelve weeks after AOM, the type B tympanogram was still observed in 21 (15%) of the affected ears and in 16 (11%) of the unaffected ears. Ears with type B changes at presentation showed a significantly slower recovery of middle ear ventilation than did those with either type A or type C1.

Bilateral carcinomas of the maxillary sinus

We report a 68-year-old male with a rare case of synchronous bilateral carcinomas of the maxillary sinus. A CT scan revealed a large tumour mass that extruded from the left maxillary sinus; tissue of soft density filled the right antrum which had intact bony walls. A probe antrostomy on the right side disclosed a tumour which was diagnosed histologically as the same poorly differentiated squamous cell carcinoma as that in the left antrum. The incidence and aetiology of this disorder are presented, and its diagnosis and management are discussed.

Vascular reconstruction of carotid artery invaded by extensive parotid gland carcinoma

A 63-year-old male with the left parotid gland carcinoma was operated with the reconstruction of the left carotid artery after the left radical neck dissection. The greater saphenous vein was used for the vein graft between the left common carotid artery and the medial cerebral artery. Postoperatively, a temporary loss of consciousness and a half body paresis of the contralateral side occurred, but they were recovered completely in 12 hours. Postoperative angiography showed a good blood flow in the reconstructed vessel.

Effects of physical exercise and cold stimulation on serum testosterone level in men

The concentrations of testosterone (TS) and other related hormones in serum were examined before and after physical exercise with a bicycle ergometer (90 Watts, 20 min.) and a cold water stimulation in 32 19-year-old males. While exercising, the serum TS level significantly increased by 20.8% (p less than 0.05), the luteinizing hormone (LH) level by 3.6% (p less than 0.05) and noradrenaline (NA) level by 140.0% (p less than 0.01). During cold water stimulation, TS decreased by 10.0%, LH increased by 22.1% and NA decreased by 23.8%. Based on changes in hormone levels within the individual during the loads. there was a significant positive correlation coefficient (r) between TS and LH, and between TS and NA, with r (TS-LH) = 0.399 (p less than 0.05) and r (TS-NA) = 0.481 (p less than 0.05) for physical exercise, while r (TS-LH) = 0.403 (p less than 0.05) and r (TS-NA) = 0.431 (p less than 0.05) for cold water stimulation, respectively. These results suggest that physical exercise increases TS level in serum by increasing LH and NA levels, but these tendencies were not found with cold water stimulation.

Relation of serum and erythrocyte magnesium levels to blood pressure and a family history of hypertension. A follow-up study in Japanese children, 12-14 years old

Serum and erythrocyte magnesium concentrations (S-Mg, E-Mg) were measured in 122 junior high school students followed up for two years from 12 to 14 years of age, and the relationship to blood pressure and a family history of hypertension were investigated. The subjects who had high S-Mg and E-Mg levels at the first examination two years prior tended to show high levels after this follow-up. There were significant positive correlations between two intraindividual values of S-Mg and E-Mg. A similar tendency was found for blood pressure. Tracking phenomena were observed with these measures. The subjects who had high E-Mg levels at the first examination showed no blood pressure elevation during the two-year period. The subjects with a family history of hypertension [FH(+)] showed a higher degree of blood pressure rise during two years than those with no family history [FH(-)], with a significant difference in systolic blood pressure at the age of 14. E-Mg tended to be lower in the FH(+) group than in the FH(-) group with a significant difference in 14-year-old girls. These results suggest that a hereditary predisposition to hypertension is related to magnesium metabolism and that intracellular magnesium deficiency may influence blood pressure elevation in the FH(+) children.

Plasma and erythrocyte magnesium concentrations in thyroid disease: relation to thyroid function and the duration of illness

To clarify magnesium metabolism in thyroid dysfunction, plasma and erythrocyte magnesium concentrations (P-Mg, E-Mg) were determined in patients with untreated thyroid diseases and their relations to thyroid hormone levels and the duration of illness were examined. P-Mg was significantly lower in hyperthyroid patients than in euthyroid or hypothyroid individuals. E-Mg was significantly higher in hypothyroid patients than in hyperthyroid or euthyroid individuals. In the entire series of 84 subjects, both P-Mg and E-Mg showed significant negative correlations with thyroid hormone levels, but the correlations were greater in P-Mg than E-Mg. In hyperthyroid patients, both P-Mg and E-Mg were negatively correlated with the duration of illness, but this correlation was greater in E-Mg than P-Mg. Also, both P-Mg and E-Mg were significantly higher in patients with destructive thyroiditis with a short duration (0.5 months) such as subacute or painless thyroiditis than in patients with Graves' disease (4.9 months). These results suggest that magnesium metabolism in thyroid dysfunction is affected not only by thyroid hormone levels but also by the duration of illness.

An epidemiological study of plasma renin activity in schoolchildren in Japan: distribution and its relation with family history of hypertension

Plasma renin activity (PRA) was determined in a group of 610 Japanese schoolchildren aged 10-14 years in order to investigate the relationship between PRA distribution and a family history of hypertension. Plasma renin activity was higher in the subjects with a family history of hypertension (FH+) than in those without a family history of hypertension (FH-). Systolic blood pressure (SBP) was also higher in the FH+ group than in the FH- group. The FH- group showed a significant negative correlation between PRA and SBP (boys, r = -0.254, P less than 0.01; girls, r = -0.225, P less than 0.01), whereas the FH+ group showed no correlation between PRA and blood pressure. These results suggested that schoolchildren with a family history of hypertension might have an enhanced renin-aldosterone (R-A) system, resulting in elevation of blood pressure.

An epidemiologic study on the correlation between salt threshold, academic test marks, biochemical data, number of complaints, and personality in women college students

One hundred nine 19-year-old female students were surveyed as to academic test marks; salt detection and recognition thresholds; serum cholesterol, serum uric acid, serum cortisol, and other biochemical indices in serum; urinary sodium/creatinine and potassium/creatinine, as well as number of complaints based on the Cornell Medical Index (CMI) and personality based on the Yatabe-Guilford (Y-G) test. The salt recognition threshold showed a high negative correlation with serum uric acid concentration and a slight correlation with CMI complaint number, academic test marks, blood pressure, obesity, and serum cholesterol. The subjects with high salt thresholds had relatively passive personalities. Cholesterol, uric acid, hemoglobin, ferritin, and glucose levels in the serum were higher in the group with higher academic marks. These students also had fewer complaints and more of them were type B individuals based on the Y-G test. They also seemed to be under greater stress. In regression analysis, the partial regression coefficient between academic test marks and serum cholesterol was 60 percent higher than that between academic test marks and serum uric acid. Students who lived on campus had 24.8 milligrams per deciliter (15.7 percent) more serum cholesterol and 3.8 micrograms per deciliter (37.7 percent) more serum cortisol than those who commuted from home.