[Thalamic infarction in young adult caused by embolism from an unruptured aneurysm of the posterior cerebral artery--a case report]

A 21-year-old man presented with sudden weakness and dysesthesia of his right limbs. Computerized tomography (CT) scan showed a low density area in the posterolateral part of the left thalamus. Right vertebral angiography revealed a small aneurysm at the P2 segment of the posterior cerebral artery. Magnetic resonance imaging (MRI) demonstrated intra-aneurysmal clot and signal void in the residual lumen. There were no other lesion and no predisposing risk factors that produced cerebral ischemia. It was thought that the aneurysm was the source of emboli resulting in thalamic infarction. The patient underwent a left subtemporal craniotomy, and the aneurysm was clipped. Following surgery, there has been no recurrence of ischemic attacks. The diagnosis and the therapy were discussed, with reference to the literature.

Estrogen receptor, c-erbB-2 and nm23/NDP kinase expression in the intraductal and invasive components of human breast cancers

Expression of the c‐erbB‐2 oncoprotein (ErbB‐2) and the nm23 anti‐metastatic gene product (nucleoside diphosphate [NDP] kinase) was examined in the intraductal and invasive components of 63 fresh human breast cancer tissues. The expression of estrogen receptor (ER) as a marker of hormone dependency and the Ki‐67 protein as a proliferative cell marker was also examined. ErbB‐2 and ER were positive in 77.8% (28/36) and 64.7% (22/34) of the intraductal components, and in 43.6% (27/62) and 57.1% (36/63) of the invasive components, respectively. NDP kinase was positive in 58% (18/31) of intraductal, and in 30.9% (17/55) of invasive areas. The average Ki‐67‐positive cell rates were 5.9% in the intraductal, and 10.7% in the invasive components. Thus, the cells within the intraductal component of breast cancer appear to have different characteristics from the invasive component, not only in markers of proliferative ability, but also in the expression of oncogenes and hormone receptors.

Intracranial mycotic aneurysm caused by Aspergillus--case report

A 75-year-old female with chronic renal failure diagnosed as Wegener's granulomatosis was receiving steroids and immunosuppressive agents when subarachnoid hemorrhage developed. Cerebral angiography showed a fusiform aneurysm arising from an angular branch of the left middle cerebral artery. Hemorrhage occurred and the aneurysm was excised by emergency surgery. Microscopic examination of the aneurysm revealed dense infiltration of hyphae identified as Aspergillus. She died of subsequent hemorrhage. Autopsy showed numerous Aspergillus hyphae in the lung. Fungal mycotic aneurysm should be considered in the differential diagnosis of an immunocompromised patient with subarachnoid hemorrhage.

[Prostatic cancer after transurethral resection for benign prostatic hypertrophy]

Five cases of prostatic cancer developed after transurethral resection of prostate for benign hypertrophy are reported. Duration of transurethral resection of prostate (TUR-P) to diagnosis of prostatic cancer ranged from one year and seven months to seven years and two months, on average four years and seven months and frequency of prostatic cancer after TUR-P was estimated at 1.2%. Four of five patients complained of macroscopic hematuria. The cystourethrogram showed the mass protruded in the dilated prostatic urethra or bladder-neck in four patients (80%), a remarkable finding, and four cases were at stage D. Risk of development of prostatic cancer is not decreased even after prostatectomy and prostatic carcinoma diagnosed after TUR-P often advances in stage. Therefore, periodical examinations of the patients who had a prior prostatectomy are very important.

Simultaneous determination of a new gastrointestinal prokinetic agent (HSR-803) and its metabolites in human serum and urine by high-performance liquid chromatography using automated column-switching

A method based on high-performance liquid chromatography using column-switching is described for the simultaneous determination of HSR-803 and its metabolites in human serum and urine. The system uses a six-port valve with a Nucleosil CN pre-column for on-line sample clean-up, and direct injection of samples. The limits of quantitation in serum and urine were 5 and 20 ng/ml for HSR-803 and 50 and 200 ng/ml for the metabolites, respectively. The coefficients of variation for the intra- and inter-day accuracies were between 0.8 and 7.1% for each compound. This method was applied to the pharmacokinetic studies in humans after oral administration of HSR-803.

[Extracorporeal shock wave lithotripsy for urinary tract stones using piezoelectric lithotripter (Piezolith)]

A total of 133 stones in renoureteral and bladder units from 122 patients, 8 to 80 years old, were treated by extracorporeal shock wave lithotripsy (ESWL) with the Wolf Piezolith device from November 1989 through December 1990. The 133 stones involved renal stones (91), ureter stones (34) and bladder stones (9). The number of shock waves per session was up to 4,000 shots, the mean number of shots was 3,120. Neither anesthesia nor analgesic agents were used except for epidural anesthesia on 10 and intramuscular analgesics on 8 patients. Fragmentation into particles 4 mm in size or less occurred in 89 of the 91 renal stones (97.8%), 24 of the 34 ureteral stones (70.6%) and 8 of the 8 bladder stones (100%). The mean numbers of treatment on each stone were 3.2, 1.8 and 1.8, respectively. Ultrasound localization restricted treatment of ureteral stones to the most proximal and distal fourth of the ureter.

Retrocaval ureter with recurrent pyelonephritis

A case of retrocaval ureter with recurrent pyelonephritis is presented with discussion of these clinical entities. An excretory urogram and retrograde ureterogram disclosed pronounced hydronephrosis as well as a dilated proximal part and reversed J-shaped appearance of the right ureter. The compressed retrocaval portion of the ureter was resected and an end-to-end anastomosis was performed anterior to the vena cava. Due to the progressive kidney damage leading to severe hydronephrosis, a rapid radiological diagnosis should be made to replace the retropositioned ureter.

ANP decreases arterial oxygen partial pressure by increasing shunt flow in pulmonary circulation

This study was designed to clarify the decreased arterial oxygen partial pressure (PaO2) mechanism induced by atrial natriuretic peptide (ANP) infusion. In order to examine the effects of ANP on gas exchange across the normal lungs, ANP was infused to eight anesthetized dogs, ventilated with mixed gases of oxygen and nitrogen. PaO2 and venous oxygen partial pressure (PvO2), ventilation-perfusion ratio (VA/Q), shunt-total blood flow ratio (QS/QT) were measured before and during ANP infusion under ventilation with 10, 20, 30% oxygen. In this study ANP decreased PaO2 from 89.0 +/- 4.2 to 85.4 +/- 5.4 mmHg during 20% oxygen ventilation, and from 138.1 +/- 3.6 to 132.5 +/- 4.1 mmHg during 30% oxygen ventilation. ANP increased VA/Q and QS/QT. We conclude that the decrease in PaO2 caused by ANP infusion was mainly due to the increased venous admixture.

[Alteration ratio of lung field CT numbers of full inspiration to end expiration scans in chronic obstructive pulmonary diseases]

The alteration ratio of lung field CT numbers in different respiratory phases was studied in 52 patients with chronic pulmonary obstructive disease (COPD) and 20 subjects with normal lung. The 52 patients with COPD consisted of 30 with clinically diagnosed chronic pulmonary emphysema (CPE), 15 with suspected CPE (sCPE) and seven with bronchial asthma (BA). The 20 subjects with normal lung were divided into two groups according to age. CT images were obtained in each case under different respiratory conditions, i.e., full inspiration and end expiration. The following parameters were employed for numerical evaluation: %(I-E)Apex = (MLDApexI-MLDApexE/MLDApexE x 100 %(I-E)Mid = (MLDMidI-MLDMidE)/MLDMidE x 100 %(I-E)Base = (MLDBaseI-MLDBaseE)/MLDBaseE x 100 %(I-E)Whole = (MLDWholeI-MLDWholeE)/MLDWholeE x 100 where MLD is mean lung density and the letters I and E stand for full inspiration and end expiration, respectively. The small letters Apex, Mid, Base and Whole stand for apex cut, mid-thorax cut, base cut and whole lung, respectively. The values of %(I-E)Whole were significantly different between disease groups except for those between the sCPE and BA groups. The values of %(I-E)Whole showed a good positive correlation with FEV1.0% (r = 0.79) and V25/H (r = 0.80) and a good negative correlation RV/TLC (r = -0.75). Diagnostic differentiation of COPDs by %(I-E)Whole values identified 80% of CPE cases and 91% of normal lung cases. In the sCPE group, the values of %DLco in patients with %(I-E)Whole above 9% were smaller than those in patients with %(I-E)Whole under 9%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phase II study of 5'-DFUR (Furtulon) capsule for bladder cancer]

A cooperative phase II study of 5'-DFUR at a daily dose of 800 to 1,200 mg was performed on 18 patients with bladder cancer. The therapeutic responses were evaluated by Koyama-Saito's criteria in 13 out of 18 patients, and 3 PR, 1 MR, 6 NC and 3 PD were obtained. Adverse reactions were observed in three out of 15 cases (20.0%). These side effects were reversible gastrointestinal symptoms such as nausea-vomiting, anorexia and diarrhea. The results suggest that 5'-DFUR is a useful drug for bladder cancer treatment.

Primary adrenocortical tumors in autopsy records--a survey of "Cumulative Reports in Japan" from 1973 to 1984

All cases of primary adrenocortical tumors, including those found incidentally, recorded in the Pathological Autopsy Case Annuals of Japan during a 12 year period from 1973 to 1984 were surveyed. Age- and sex-specific incidences of lesions were estimated from the population, mortality and autopsy statistics for the same period. There were 101 adenomas, 77 of which were presumed to be non-functional, and 222 carcinomas. The age-specific distribution profiles of both the benign and malignant tumors showed single peaks in the sixties and could not be distinguished from one another. The estimated age-specific distribution of morbidity of the non-functional adenomas showed a peak at about 10 years younger than that found in the autopsy records, although it was again similar to that of carcinoma derived from various clinical reports. The morbidity of the non-functional adenomas per 100,000 population was almost equal to that of breast cancer in Japan, being highest in the fifties age group with more than 4,000 people a year being suggested to have adenoma in this age bracket.

[Analysis of pyrophillitosis by high-resolution computed tomography]

High-resolution computed tomography (HR-CT) was performed on 20 patients with pyrophilitosis. Small nodular opacities in these patients could be divided by HR-CT into two types, namely, tiny irregular branching structures (TIB) and small round opacities (SRO). TIB had a centrilobular distribution and were characteristic of pyrophillitosis. SRO had both centrilobular and perilobular distributions and were considered to be changes modified by the aspiration of silica. Large opacities (LO) of pyrophillitosis were classified into three types, that is, spherical type, flat type parallel to the bronchus and flat type parallel to the thoracic wall. The spherical type was seen in patients exposed to both pyrophillite and silica, while the flat types were seen in patients exposed to only pyrophillite and were characteristic opacities of pyrophillitosis. Pulmonary emphysema was found in only one patient with pyrophillitosis, whereas mediastinal lymph node swelling and calcification were seen in most patients with pyrophillitosis. HR-CT is useful in making a more accurate evaluation of these lesions.

[Clinical and pathological study of tumor marker in benign prostatic hypertrophy and incidental prostatic cancer]

To determine the value of prostatic markers for prostate cancer, serum prostatic acid phosphatase (PAP), prostate specific antigen (PSA) and gamma-Seminoprotein (gamma-Sm) were measured in 81 patients with benign prostatic hypertrophy and in 12 patients with incidental prostatic cancer. gamma-Sm was the most sensitive but the least specific of the three markers. Large prostate glands, especially hyper-glandular type tended to be associated with high gamma-Sm levels in our study. Patients with acute urinary retention, acute prostatitis and necrosis also showed positive markers. Out of 12 patients with incidental cancer, 5 patients had more than 2 elevated markers. Four patients with poorly differentiated adenocarcinoma failed to show increased markers.

[Complete remission of lung metastases of bladder tumor treated by small dosage of UFT: a case report]

The patient was a 61-year-old woman with bladder cancer presenting in stage pT3a, N0, M0, T.C.C. (GIII) greater than S.C.C. Following total cystectomy and one course of cisplatin, adriamycin, cyclophosphamide (CAP) as adjuvant chemotherapy, she was started on futraful and uracil (UFT) at a dose of 4 capsules daily and placed on observation. Since she complained of olfactory anesthesia at 2 months of treatment, the dosage of UFT was reduced to 2 capsules daily and the drug was withdrawn after another 2 months of treatment. With the detection of lung metastases one month later UFT was resumed at a dose of 2 capsules daily. At 4 months of resumed treatment the foci of metastasis completely disappeared. She has since shown a complete remission by small dosage of UFT (2 capsules daily) for 12 months or more.

[Evaluation of hepatic tumors by contrast ultrasonography with carbon dioxide]

For evaluating hepatic tumors, ultrasonograms using carbon dioxide by arterial injection (CO2US) was performed in 37 patients, including 28 hepatocellular carcinomas, 11 hepatic metastases, and 3 hepatic hemangiomas. Hepatic tumors were enhanced by CO2US and easily identified. CO2US of hepatic tumors were classified into six patients. Generally, on CO2US hepatocellular carcinomas were well enhanced, and hepatic metastases had ring-like enhancement. Hepatic hemangiomas showed peripheral patchy enhancement. In the patients with hepatocellular carcinoma, the primary tumors were better identified on CO2US than conventional sonography. The daughter nodules with hepatocellular carcinoma were also better demonstrated than other examinations. CO2US is helpful in evaluating and differentiating hepatic tumors.

[The evaluation of the effect of Estracyt on prostatic cancer]

The clinical effect of Estracyt on untreated prostatic carcinoma was evaluated. The subjects consisted of 51 of 71 patients with prostatic carcinoma who were observed for 6 months or more after oral administration of 560 mg of estramustine phosphate. This drug was effective in all patients: markedly effective in 34 (66.6%), moderately effective in 13 (25.5%), and slightly effective in 4 (7.8%). During the observation period varying from 6 months to 2 years and 6 months, 7 patients had recurrence of progression. The interval between the drug administration and recurrence of progression varied from 6 months to 1 year and 10 months (mean, 15.8 months). Prostate acid phosphatase and gamma-seminoprotein remained normal between 3 and 15 months after the administration but became elevated due to recurrence of progression after 18 months or more in some patients. Blood testosterone, luteinizing hormone, and follicle stimulating hormone decreased while blood cortisol increased. Therefore, estrogen was acting effectively. Side effects were observed in 56.9% of the patients, the most frequent being mazoplasia in 33 patients (45.8%), and cardiovascular complications and apoplexy in 11 patients (15.3%). Estracyt was effective for untreated prostatic carcinoma but the problems such as recurrence of progression and side effects require further examination.

[A case of renal adenocarcinoma with oxalate calcification on long-term hemodialysis]

A 39-year-old man with a 13-year history of hemodialysis was hospitalized with left back pain in May 1989. The plain radiograph showed a calcification in the left kidney. Ct scan demonstrated a round high density area. We could not exclude the possibility of malignancy, therefore, we performed left nephrectomy. Pathological examination revealed that a tumorous mass in the renal parenchyma and renal adenocarcinoma was confined to the mass intermingled with the deposition of the oxalate crystals. It was difficult to diagnose. Therefore we recommend nephrectomy when the diagnosis is uncertain.

Heterogeneity of serum and amniotic fluid prolactin in humans

The molecular heterogeneity of PRL was studied in serum and amniotic fluid using immunoperoxidase electrophoresis. In the amniotic fluid, larger molecular variants (greater than 117 kD), small PRL (20 and 23 kD) and cleaved PRL were present in the nonreduced condition. Newly, three mercaptoethanol (MCE)-resistant forms (76, 64 and 53 kD), and 25- and 23-kD forms appeared after treatment with MCE. Two variants, 64 and 23 kD, did not bind to concanavalin A (Con A), indicating a simple peptide without sugars. Other glycosylated forms, 76, 53 and 25 kD, bound to Con A. In maternal serum, the same components as those in the amniotic fluid were seen, except for a scanty amount of 23 kD and a newly appearing glycosylated variant of 28 kD in the reduced condition. This 23-kD form also appeared with the administration of TRH in women.

[Internal rotation angle measurement of the elbow with 3D reformatted CT image]

The examination of internal rotation angle at the elbow is difficult on conventional radiographs. The angle of internal rotation has been measured with three dimensional reformatted CT image of GE CT/T9800. The angle of internal rotation with the cubitus varus deformity was measured both preoperatively and postoperatively. Postoperatively the angle of internal rotation became equal on both sides. Three dimensional CT reconstruction is useful in determining the internal rotation angle of elbow.

[A case of small cell carcinoma of the ureter]

We report a case of primary undifferentiated small cell carcinoma of the ureter. A 62-year-old man showed gross hematuria. Retrograde pyelography and CT scan revealed a tumor in the left ureter. The light microscopic examination revealed small cell carcinoma and transitional cell carcinoma. To the best of our knowledge, this is the first report of a small cell carcinoma originating in the ureter in Japan.

Transfemoral closure of patent ductus arteriosus: an alternative to surgery in older patients

Two patients with congestive heart failure underwent successful closure of patent ductus arteriosus (PDA) at ages 58 and 63, respectively, using the transfemoral technique of Porstmann and Sato. The long-term benefits obtained in these two patients suggests a potential role for this technique in the elderly patient with PDA.

[A case of erythropoietin-producing renal cancer]

A case of renal cell carcinoma with erythrocytosis is reported. A 58-year-old male had a right renal tumor with retroperitoneal lymph node and lung metastases. Preoperative laboratory data revealed a red blood cell count of 6.31 million/mm3, a hemoglobin concentration of 17.2 g/dl, a hematocrit of 52.1, and an erythropoietin (EPO) level of 47.3 mU/ml, which was determined by RIA method (normal range: 8-30). The patient underwent radical nephrectomy and retroperitoneal lymph node dissection without any blood transfusion because blood loss was only 300 g. The removed kidney weighed 400 g. Pathological examination showed a renal cell carcinoma not invading the fibrous capsule with lymph node metastasis. The EPO activities of extracts from the normal kidney and cancer tissues were less than 18 and 50.8 mU/g, respectively. At present, 3 months postoperatively, he receives daily UFT and HLBI every other day for the lung disease left, which does not change in size, and all laboratory data mentioned above have returned to normal ranges. These results enabled us to diagnose the present case as EPO-producing renal cell carcinoma.

[Follow-up pulmonary perfusion scintigraphy pulmonary arterial embolization in two cases of familial pulmonary arteriovenous fistula]

Follow-up pulmonary perfusion scintigraphy in evaluating pulmonary arterial embolization were assessed by two cases of pulmonary familial arteriovenous fistula. Pulmonary arteriovenous fistula was found for brain abscess in the older brother, and for dyspnea on effort in the younger brother. Pulmonary arterial embolizations were performed. (older brother: 4 times, younger brother: 5 times) Before embolization, pulmonary perfusion scintigram showed pale defect, clear asymmetric perfusion between right and left lung, and clear renal visualization. On the other hand, after the embolization, clear multiple defects agreed with the sites of embolization, and asymmetric pulmonary perfusion and renal visualization disappeared. We conclude that follow-up pulmonary perfusion scintigraphy is useful to evaluate in pulmonary arteriovenous fistula after embolization.

[A case of bladder cancer with bilateral ureteral carcinoma in situ]

A case of bladder cancer with bilateral ureteral carcinoma in situ (CIS) is presented. A 55-year-old male had gross hematuria and urinary retention. Cystoscopy revealed diffuse broad-based papillary tumors, which proved to be transitional cell carcinoma (G2) with CIS and submucosal invasion microscopically. Excretory urography showed normal upper urinary tracts except stasis of bilateral lower ureters. Neither lymph node swelling nor distant metastasis was found by computed tomography. Therefore the patient underwent total cystourethrectomy, pelvic lymph-adenectomy, and construction of an ileal conduit. Histological examination of the specimens demonstrated CIS on bilateral ureteral stumps on the renal side, which, however, was not continuous to that of the bladder. Much attention should be paid to upper urinary tracts for ureteral lesions before cystectomy in such bladder tumors and the proximal stump of the ureter should be examined using frozen section at the operation, but these were not sufficient in the present case in which skip lesions of the ureters were seen apart from the bladder.