Volume-weighted mean nuclear volume as a prognostic factor in renal cell carcinoma

Volume-weighted mean nuclear volume (MNV) has been reported to have important prognostic value in many cancers. We investigated the prognostic value of MNV in patients with renal cell carcinoma (RCC). A retrospective study of the 155 patients with RCC treated by radical nephrectomy between 1976 and 1996 was conducted. MNV was evaluated in the surgical specimens using a stereologic technique. Univariate analyses by the log-rank test and then a multivariate analysis by the Cox proportional hazards model were performed to analyze the prognostic value of histopathologic parameters such as Robson stage, tumor-node-metastasis (TNM) classification, tumor grade, and MNV. There were significant correlations between MNV and Robson stage, TNM classification and tumor grade. Robson stage, TNM classification, tumor grade, and MNV were correlated significantly with disease-specific survival of RCC patients. There was no significant difference in disease-specific survival between patients with Grade 1 and Grade 2 tumors (94.8% of all patients), but MNV could predict the clinical outcome of these groups. MNV also was correlated significantly with disease-specific survival at all tumor stages. Multivariate analysis showed pT classification, M classification, tumor grade, and MNV to be independently associated with survival. These studies strongly suggest that MNV may provide new and useful information to accurately predict the prognosis of patients with RCC.

[Laparoscopic nephropexy for symptomatic nephroptosis: a case report]

We present our clinical findings of laparoscopic nephropexy performed on a 32-year-old woman with symptomatic nephroptosis. Supine and erect excretory urography (DIP) revealed right renal descent of 2.5 vertebral bodies with hydronephrosis. Laparoscopic transperitoneal nephropexy was performed using nonabsorbable sutures, polyglactin net, hernial staplers and tissue adhesive. An upright DIP 1 month postoperatively revealed renal descent of only 1 vertebral body and no hydronephrosis. One year postoperatively, the patient is asymptomatic. A laparoscopic procedure, which is safe, effective and causes minimal morbidity, represents an excellent approach for repair of symptomatic nephroptosis.

[Multivariate analyses by quantitative method II of subjective pitch and tonality of tinnitus]

Factors affecting subjective tinnitus pitch and tinnitus tonality were analyzed with the use of the quantitative method II. Ninety-one patients with unilateral tinnitus of a single kind were studied. Major factors affecting subjective tinnitus pitch were pitch matched frequency, age, puerility and impurity of tinnitus tonality, and loudness of tinnitus. In addition, major factors affecting puerility and impurity of tinnitus tonality were pitch matched frequency, loudness of tinnitus, and nature of the test tone. Furthermore, subjective puerility of tinnitus was associated with middle-pitched frequency and high-pitched frequency, and a loudness level of tinnitus between 25 and 49 dB HL. Whereas impurity of tinnitus was related to low-pitched frequency and noise of the test tone. These results may contribute to the clinical evaluation of tinnitus.

Granulomatous nephritis as a complication of intrarenal bacille Calmette-Guérin therapy

A case of granulomatous nephritis after intrarenal bacille Calmette-Guérin (BCG) therapy is reported. High fever greater than 38.5 degrees C lasted for 1 month, without response to conservative therapy. Standard nephroureterectomy was subsequently carried out. Histopathologic findings from the surgical specimen were compatible with BCG-induced granulomatous nephritis. The use of a syringe pump for retrograde instillation of BCG was thought to be the major cause of this severe complication.

[Bilateral breast metastases from prostatic carcinoma: a case report]

We report a case of bilateral breast metastases from prostatic carcinoma. A 49-year-old man with stage D2 prostate cancer, who had been treated by chemoendocrine therapy and radiotherapy for 2 years, complained of bilateral enlarged breasts. Oral administration of diethylstilbestrol diphosphate was started 2 months before the onset of this symptom. A firm mass that was not tender was palpable beneath the skin without fixation on each side. A needle biopsy of the masses showed poorly differentiated adenocarcinoma with positive immunohistopathological staining for prostate-specific antigen. The masses were diagnosed as metastatic adenocarcinoma of prostate gland origin. The patient died 3 months after the diagnosis of breast metastases. Autopsy revealed diffuse lymphogenous metastatic disease. Metastatic prostatic carcinoma to the breast is uncommon. Breast metastases in this patient might be associated with diffuse lymphogenous metastases as well as increased local blood and lymphatic supply caused by extrinsic estrogens.

[Multivariate analyses using quantitative method II of annoyance due to tinnitus]

Factors affecting annoyance due to tinnitus were analyzed using quantitative method II. Ninety-one patients with unilateral tinnitus of single kind were studied. Major factors affecting annoyance due to tinnitus were found to be subjective loudness of tinnitus, age, degree of hearing loss, tinnitus loudness level in dB HL, pitch matched frequency, puerility and impurity of tinnitus tonality, and subjective tinnitus pitch. Increased annoyance due to tinnitus was associated with an age of 30-49 years, a tinnitus loudness level between 25 and 49 dB HL, a tinnitus loudness level more than 15dB SL, impurity of tinnitus tonality, larger subjective loudness, and high-pitched tones above 4000Hz. Decreased annoyance due to tinnitus was related to the smaller subjective loudness, loudness level below 25dB HL, low-pitched tones below 250Hz, and purity of tinnitus tonality. Our results suggest that these factors are responsible for individual differences in annoyance caused by tinnitus.

A 'neural' response with 3-ms latency evoked by loud sound in profoundly deaf patients

A large negative deflection with a latency of 3 ms was observed in the auditory brainstem response (ABR) waveforms of some patients with peripheral profound deafness. This deflection was termed the N3 potential. In this paper, we review patients with the N3 potential and discuss the characteristics of abnormal ABR waveforms. The origin of the N3 potential was also discussed, especially with respect to vestibular evoked potentials. In most of the patients, audiograms showed no response to the maximum output of an audiometer in the high-frequency range and a residual response in the low-frequency range. The N3 potentials were noted at intensities of 80 dB nHL or greater. As the stimulus intensity increased, the amplitude of the potential increased and the latency decreased. A high repetition rate (83.3/s) of the click stimulus influenced the latency and amplitude of the N3 potential. The potential was replicated on retest within less than a month, and had a consistent latency and amplitude over the scalp. The results indicate that the N3 potential is not an electrical artifact but a physiological neural response evoked by a loud sound. The N3 potential is most likely not an auditory evoked response from cochlear or a response from a semicircular canal, because it has a 3-ms latency, a sharp waveform, and is unassociated with vertigo. The results suggest that the N3 potential may be a saccular acoustic response.

Coherence analysis of EEG changes during olfactory stimulation

In a pilot study, EEG changes during odor stimulation were evaluated by coherence analysis. Ten normal adults were studied. Simultaneous recordings of 16 EEG channels with and without odor stimulation were stored on magnetic tape for further processing. EEG signals were analyzed using a signal analyzer. Coherence spectra were calculated between all possible channel pairs on the scalp. The amount of data was reduced by extracting broad band coherence values for five frequency bands: delta (2-3.9 Hz), theta (4-7.9 Hz), alpha 1 (8-9.9 Hz), alpha 2 (10-12.9 Hz), and beta 1 (13-17.9 Hz). Coherence values extracted from the control EEG recordings and those during odor stimulation were compared to evaluate the presence of any significant differences. The results demonstrated significant changes in the EEG coherence between the two control recordings (before and after) in the theta and beta 1 bands. These frequency bands were therefore excluded from the examination. During odorant stimulation with methyl-cyclopentenolone, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased in the bilateral temporal region. During odorant stimulation with scatol, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased in the frontal, temporal and occipital regions. It is suggested that EEG coherence mapping may provide the basis for the development of an objective test of olfactory function in humans.

Successful treatment with polymyxin B immobilized fiber of septic shock complicated by renal stone

We describe a patient with septic shock that was spontaneously complicated by calyceal diverticular calculus. The patient recovered from shock within a few days with treatment by extracorporeal elimination of endotoxin using a blood purification cartridge consisting of polymyxin B immobilized fiber. Standard open nephrolithotomy was performed, and the patient was discharged from the hospital 2 months after admission.

[Negative potential auditory brainstem response with 3-msec latency in profoundly deaf patients: characteristics and relationship to vestibular evoked response]

A large negative deflection with a latency of 3 msec was observed in the auditory brainstem response (ABR) waveforms of 48 patients (6.5%), [59 ears (5.8%)] in 740 patients with profound peripheral deafness (1,009 ears) between 1978 and 1990 at our department. This negative deflection was termed the "N3 potential." We reviewed some of these patients and discuss some common characteristics found in abnormal ABR waveforms. We also inquired into the conditions and origins of these potentials. Although virtually all patients were less than 10 years of age, the N3 potential was also observed in the ABR waveform of adult patients. There were no sex differences. In the majority of patients audiograms showed no response to the maximum output of an andiometer in the high frequency range and a residual response in the low frequency range. The most common cause of deafness was "unknown" in children, and "sudden deafness" in adults. The N3 potentials were noted at intensities of 80 dBnHL or greater. A high repetition rate (83.3/sec) of the click stimulus influenced the latency and amplitude of the N3 potential. As the stimulus intensity increased, the amplitude of the potential increased, and the latency decreased. The potential was replicated on retesting within less than a month. The N3 potential had a consistent latency and amplitude over the scalp. We conclude that the N3 potential was a physiological "neural" response evoked by a loud sound rather than by an electrical artifact. The N3 potential was most likely not an auditory evoked response or a response from a semicircular canal, because of the 3-msec latency and sharpness of the waveform, with lack of vertigo. The results suggest that the N3 potential may be a saccular acoustic response.

[A case of Fournier's gangrene with healing accelerated by argatroban]

A 58-year-old man was admitted to our hospital complaining of pain and marked swelling of scrotum and perineum. Physical and radiological examinations revealed gas-producing gangrenous changes involving the scrotum. Debridement was urgently carried out. Following the debridement under control of diabetes mellitus, antimicrobial agents and argatroban, a newly synthesized antithrombin medicine, were administered. Argatroban was used for the purpose of improving vascular insufficiency. Healthy granulation tissue was present five weeks later. Then surgical closure was carried out. Computed tomography was useful to make early diagnosis, and argatroban was thought to accelerate healing of the gangrene.

Pyogenic vertebral osteomyelitis after acute bacterial prostatitis: a case report

A case of pyogenic vertebral osteomyelitis after acute bacterial prostatitis in a 78-year-old man is reported. The rarity and subtle clinical presentation of this condition, and the delayed appearance of radiologic signs of progression to destructive osteomyelitis, contributed to a significant delay in diagnosis. An arterial blood culture positive for bacterial growth during the episode of acute prostatitis suggested that bacteremia might result from hematogenous spread of the infection to the vertebral column via the venous system. Since intensive antimicrobial therapy proved ineffective, debridement of the first and second lumbar vertebral bodies, and anterior spinal fusion from the twelfth thoracic to the third lumbar vertebrae were performed. The patient's high fever and severe lumbago subsided immediately after the surgery. The possibility of development to pyogenic vertebral osteomyelitis should be kept in mind when treating a serious genitourinary tract infection.

Coherence analysis of EEG changes during odour stimulation in humans

In a pilot study, EEG changes during odour administration were evaluated by coherence analysis. Ten normal adults were studied. Simultaneous recordings of 16 EEG channels with, and without, odour administration were stored on magnetic tape for further processing. EEG signals were analysed using a signal analyser. Coherence spectra were calculated between all possible channel pairs on the scalp. The amount of data was reduced by extracting broad band coherence values for five frequency bands: delta (2-3.9 Hz), theta (4-7.9 Hz), alpha 1 (8-9.9 Hz), alpha 2 (10-12.9 Hz), and beta 1 (13-17.9 Hz). Coherence values extracted from the control EEG recordings and those during odour administration were compared to evaluate the presence of any significant differences. The results demonstrated significant changes in the EEG coherence between the two control recordings (control before and control after) in the theta and beta 1 bands. These frequency bands were therefore excluded from the examination. During odorant stimulation with methyl-cyclopentenolone, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased in the temporal region. During odorant stimulation with scatol, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased between the longitudinal electrode locations. It was suggested that EEG coherence mapping may provide the basis for the development of an objective test of olfactory function in humans.

A device for controlling odorant stimulation and olfactory evoked responses in humans

We developed a device for odorous stimuli control to record olfactory evoked responses from the human scalp. The characteristics of the apparatus are as follows. Translating the subject's respiration into electric signals with a sensor attached to the nose. The period and timing of odorous stimuli could be adjusted, so that stimuli could be synchronous with respiration. The interstimulus interval could be arbitrarily selected once every 1 to 9 respiration(s) so that adaptation could be prevented. We obtained evoked responses to odorous stimuli using this apparatus from the human scalp, whose positive peak latencies were approximately 350 and 700 msec. Such responses were not recorded if oxygen stimuli were used instead of odorous stimuli or with click sounds produced by the switching electromagnetic valve. Three types of odorant evoked scalp potentials were obtained in normal human subjects. The first type consisted mainly of two positive peaks with a peak latency of about 350 msec (P350) and about 700 msec (P700). The second type and the third type consisted of only one positive peak with a peak latency of about 350 msec and 700 msec, respectively. Such a P350 or P700 peak as that observed in the normal subjects was not detected in anosmic patients.

Topography of binaural interaction in the auditory brainstem response

The scalp topography of binaural interaction (BI) in the auditory brainstem response (ABR) was studied in fourteen normal individuals. BI was observed from all recording sites of the scalp, and the peak amplitude was noted mostly in the bilateral parietal and occipital regions. There was a significant difference in amplitude shown by significance probability mapping (SPM) when the waveform obtained by binaural stimulation was compared with the sum of the waves obtained by monaural stimulation. The topography of BI was different from that of the wave III and the wave IV/V complex. In contrast to previous reports by other workers, we found that BI mainly corresponded to the first half of the wave IV/V complex.

Analysis of auditory brainstem response waveforms derived ipsilaterally and contralaterally to monaural stimulation

The auditory brainstem responses (ABRs) obtained from 28 normal healthy adults were studied using the ipsilateral and contralateral recordings from the positions of vertex and each mastoid to monaural stimulation. Each wave of ABRs recorded by ipsilateral and contralateral derivations to stimulation site showed slightly significantly differences. Comparing the ipsilateral and contralateral data, the latencies of waves II and V showed a slightly small reduction in the ipsilateral recording, while these of waves III and IV showed a small increase. Next, the distributions of potentials and latencies of waves II to V were investigated from ABRs situating different electrodes in mid-coronal array of the scalp and non-cephalic reference electrode on the seventh cervical vertebra (CVII). The results of latencies showed the reverse relation to the data obtained from the ipsilateral and contralateral recordings using the reference electrodes on each mastoid. These facts suggest that the comparable differences of latencies in the bilaterally recorded ABRs are explained by the pseudo-phenomena of differential recordings, which the phase delayed or advanced potential propagated to each mastoid being reference electrode position.

[Flow cytometric DNA analysis and chemosensitivity in squamous cell carcinoma of the head and neck]

Cellular DNA content and succinate dehydrogenase activity of 92 human head and neck (34 laryngeal, 24 pharyngeal, 21 oral cavity, 13 maxillary) squamous cell carcinomas were examined, and DNA ploidy status and chemosensitivity were analyzed and compared. DNA aneuploidy was observed in 54 tumors (58.7%). The aneuploid pattern was most common in tumors of the maxillary sinus (84%), and least common in tumors of the larynx (41.3%). Histologically, aneuploidy was detected in 71.4% of poorly-differentiated, 63.8% of moderately-differentiated and 37.5% of well-differentiated squamous cell carcinomas. There was a statistically significant difference between the survival rates of patients with diploid and aneuploid patterns. Chemosensitivity was determined by exposing fresh tumor material to five antitumor drugs: adriamycin (ADM), cisplatin (CDDP), carboquone (CQ), 5-fluorouracil (5-FU) and mitomycin C (MMC). The average decrease in succinate dehydrogenase (SD) activity was 49.8% with ADM, 33.6% with CDDP, 39.9% with CQ, 68.4% with 5-FU and 45.5% with MMC. Histologically, poorly-differentiated squamous cell carcinomas were most sensitive to these five antitumor drugs. We also compared average SD activity in tumors from different organs and found that pharyngeal tumors tend to be most sensitive to these drugs, except for MMC. The chemosensitivity of a tumor with DNA diploidy tended to be higher among well- and moderately-differentiated squamous cell carcinomas. In contrast, tumors with DNA aneuploidy tended to have higher chemosensitivity in the poorly-differentiated type. The results of this study indicate that simultaneous analysis of DNA ploidy and chemosensitivity will be helpful in understanding the characteristics of tumors as well as in predicting the most effective chemotherapy agents for head and neck cancer patients.

Middle ear cholesteatoma extending into the petrous apex: evaluation by CT and MR imaging

CT and MR imaging findings were reviewed in four cases of acquired cholesteatoma of the middle ear that extended medially into the petrous apex and middle cranial fossa. In one case the lesion further extended anteromedially into the sphenoid sinus. CT demonstrated the lesions as nonenhancing hypodense masses with bone destruction, extending medially from the middle ear cavity to the petrous apex region. On MR imaging, the lesion was slightly hypointense relative to brain on T1-weighted images and hyperintense on T2-weighted images. MR imaging clearly delineated the extraaxial location of the lesion and associated brain displacement. The medial extension of the cholesteatomas seems to have proceeded via a detour around the bony labyrinth into the petrous apex region by following normal pathways of temporal bone pneumatization.

[Prognostic factors of common epithelial ovarian cancer treated by surgery and cisplatin based combination chemotherapy]

Retrospective analysis of prognostic factors in 171 patients who had common epithelial ovarian cancer (WHO) and treated by surgeries and cisplatin based combination chemotherapies were performed by survival assay and multivariate analysis. In FIGO stage 3, the estimated parameter values were in following order: residual tumour age grade performance status histological type. On analysing Stage patients, histological grading and histological typing had an effect on prognosis. Patients with grade 2 or tumours had a worse prognosis than did those with grade 1 tumours, and patients with clear-cell carcinoma or undifferentiated adenocarcinoma showed a poor prognosis.

Eye movements induced by lateral tilt and testing of otolithic function

In the last few years, we have studied ocular reflexes caused by tilting stimulations in test subjects placed in an upright sitting position on a chair apparatus which tilts continuously. In healthy persons, a weak nystagmus can be observed, and involves a nystagmus of minor amplitude and showing a small number of beats. The actual incidence of nystagmus in the younger group was minimal, but it tended to increase with age. This occurrence is considered to be due to age-related degeneration of the otolithic organ. Patients with vertigo and/or dizziness clearly develop nystagmus. These responses are classified as follows: type I is of fixed direction; type II is of changed direction; and type III is a combination of the first and second types. Among the peripheral vestibular disorders, particularly involving those patients with benign paroxysmal positional vertigo, a nystagmus of changed direction was found. This type was rarely seen in patients with other vestibular disorders, but was a common occurrence in healthy individuals who readily experienced motion sickness. These observations have led us to conclude that patients with benign paroxysmal positional vertigo have definite reactions which are similar to those of individuals with motion sickness, and that such depends on the susceptibility of the otolithic organs.