[Bilateral synchronous renal cell carcinoma: a case report]

A case of bilateral synchronous renal cell carcinoma is reported. The patient was a 55-year-old man. A right renal tumor was pointed out by ultrasound during a health check in July, 1994. Enhanced CT scan and angiography revealed bilateral renal tumors. Right nephrectomy and left partial nephrectomy were performed on November 25, 1994. Both tumors were completely encapsulated. Histological examinations of these tumors revealed renal cell carcinoma, Expansive type, alveolar type, clear cell subtype, G2, INF alpha, pT1, pV0.

[A case of renal cell carcinoma extending into the inferior vena cava in a long-term hemodialysis patient]

We report a case of left renal cell carcinoma extending into the inferior vena cava associated with the acquired cystic disease of the kidney (ACDK). The patient was a 46-year-old man, who had been treated with hemodialysis for 12 years. In November 1992, ACDK was observed on computed tomography (CT) for routine check up, but no tumorous lesions were detected. He noticed bleeding from the urethra in May 1994. CT and magnetic resonance imaging (MRI) revealed left renal tumor with intrahepatic vena caval tumor thrombus. There were no findings of distant metastasis. Left radical nephrectomy and partial removal of vena cava were performed. Histopathologically, renal cell carcinoma, pT3b, pN0, stage III was diagnosed.

Refractory haemospermia: any predictive factors?

A total of 56 patients with haemospermia were reviewed. Twenty-four patients suffered from prolonged haemospermia for more than 1 month or recurrent haemospermia (refractory group). In 32 patients haemospermia disappeared within a month (non-refractory group). Patient age in the refractory group was significantly higher than that in the non-refractory group (p < 0.05). Clinical symptoms other than haemospermia, white blood cell counts in the semen, expressed prostatic secretion and urine after prostatic massage, and transrectal ultrasonography findings were studied in both groups, with no significant differences found in any of these parameters. We concluded that, among these clinical findings, only patient age is a predictive factor for refractory haemospermia.

[Serial change of 123I-BMIPP SPECT imaging during recovery from stunned myocardium after acute myocardial infarction--correlation with 201Tl and two-dimensional echocardiography]

Using 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP), we investigated changes in myocardial fatty acid metabolism at recovery from stunned myocardium after acute myocardial infarction (AMI), correlation with recovery of regional wall motion and thallium-201 (201Tl) distribution in particular. The subjects were 15 patients who underwent successful reperfusion therapy after the first onset of AMI. None of the patients had multi-vessel disease or ischemic episode during their clinical course. Patients underwent 123I-BMIPP scintigraphy, 201Tl scintigraphy and two-dimensional echocardiography during the acute and chronic phases. Then, we compared regional wall motion with distribution of 123I-BMIPP and 201Tl. Regional wall motion and SPECT were evaluated by the established 16 segment model. In patients, showing serial improvement in regional wall motion, there was 80.0% (8/10) showed normal 201Tl distribution during the acute phase or normalized during the chronic phase. However, distribution of 123I-BMIPP normalized only in 10.0% (1/10) of this group. In examination of each segment that showed serial improvement in regional wall motion, 92.3% (24/26) of these segments showed normal distribution of 201Tl during the acute phase or normalized distribution during chronic phase, despite distribution of 123I-BMIPP improved in only 3.8% (1/26) of these segments. These indicate that, in the process of recovery from myocardial stunning after AMI, abnormal distribution of 123I-BMIPP continued longer than abnormal distribution of 201Tl.

Colovesical fistula due to sigmoid colon diverticulitis: a case report

We present a case of colovesical fistula due to sigmoid colon diverticulitis. A 63-year-old woman was referred to our department with the complaints of dysuria, turbid and foul smelling urine. She was treated twice for acute cystitis at the referral hospitals. A diagnosis of colovesical fistula was confirmed on barium enema. She underwent partial resection of sigmoid colon with primary anastomosis and partial cystectomy with repair of bladder wall and covered with omentum. Retrograde cytography taken on the 20th post-operative day revealed no leakage of contrast medium. She was asymptomatic at 3 months of follow-up.

D-arabinitol versus mannan antigen and candidal protein antigen as a serum marker for Candida pyelonephritis

To evaluate serum markers for the diagnosis of Candida pyelonephritis, levels of D-arabinitol, candidal mannan antigen and candidal protein antigen were measured using an enzymatic fluorometric assay, an enzyme immunoassay and a latex agglutination assay, respectively. The study group comprised 36 patients with candiduria (11 disseminated candidiasis, 9 Candida pyelonephritis and 16 colonization) and 27 without candiduria. The D-arabinitol/creatinine ratio was the only marker that differentiated between Candida pyelonephritis and colonization (p < 0.01). Using the cut-off values (1.4 mumol/mg of D-arabinitol/creatinine ratio, 0.28 of mannan/creatinine ratio (x 10(4)) and 1:4 of protein antigen titer) D-arabinitol/creatinine ratio showed the highest sensitivity in Candida pyelonephritis (77.8%) as compared to mannan/creatinine ratio (55.6%) and protein antigen titer (11.1%) although there were no differences in specificity, positive predictive value or negative predictive value. These results suggest that D-arabinitol/creatinine ratio is the most useful marker of Candida pyelonephritis.

Left ventricular-coronary sinus shunt through a septal aneurysm after mitral valve re-replacement

We describe a case in which a left ventricular-coronary sinus communication through a dissecting ventricular septal aneurysm developed after a redo mitral valve replacement. The outlet orifice of the communication was located in the side wall of the ostium of the coronary sinus. Both the communication and the aneurysm were successfully dealt with by performing a right atriotomy and by opening the aneurysm from its outlet orifice.

Ultrastructural changes in cultured glomerular epithelial cells induced by puromycin aminonucleoside: a quick-freezing and deep-etching study

The effects of puromycin aminonucleoside (PAN) on rat glomerular epithelial cells (GECs) in primary culture were studied using a quick-freezing and deep-etching method. On the 5th day after seeding, GECs were treated with PAN for 24 hours. The three-dimensional structure of the cell organelles, microtubules, and intermediate filaments were observed, primarily in the perinuclear areas of untreated GECs. Microfilaments were observed in marginal and basal areas. The GECs treated with PAN became rounded and partially detached from the substratum. Intermediate filaments formed bundled structures. A slight decrease in the number of microfilaments and a significant widening of their networks were observed in the basal areas of the GECs treated with PAN. These results suggest that PAN may affect the cytoskeletal components of GECs, such as the intermediate filaments and microfilaments, and may induce detachment of the cells from the substratum.

Reproducibility of dietary and other data from a self-administered questionnaire

This study examined the reproducibility of information obtained from a questionnaire covering dietary and other information by comparing the answers to the questionnaires with answers to the same questions one year later. Answers from 191 men and 220 women, aged 40 to 65, in Fukuoka prefecture, Japan were compared. The surveys were conducted in November 1989 and November 1990. In the second survey, 97.2% of the first respondents answered. The concordance between the two responses was high, and the differences between the mean intakes from the two surveys were within 5% for 7 food items and within 15% for 14 food items among the 20 items about which the respondents were asked. The intraclass correlation coefficients varied from 0.30 for eggs to 0.62 for milk, with 16 items greater than 0.4. The differences in reproducibility between the sexes and two age categories were not significant. Close values also were obtained for the estimated consumption of salt. A substantially high reproducibility was observed on items regarding drinking and smoking; most of the kappa statistics and the intraclass correlation coefficients were between 0.5 and 0.9. The above reproducibility on individual food items was comparable to or better than those reported from other studies. The results of the present study thus indicate that the self-administered semiquantitative food intake questionnaire used for our cross-sectional study is useful for epidemiologic studies to assess the association between diet and various diseases. In particular, the present questionnaire is highly dependable regarding the overall group intake of foods.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of fluconazole in treating prosthetic valve endocarditis caused by Candida glabrata: report of a case

A case of active prosthetic valve infective endocarditis (PVE) due to Candida glabrata was successfully treated by the systemic administration of fluconazole. A 66-year-old Japanese man with infective endocarditis of unknown etiology underwent aortic and mitral valve replacement to treat severe aortic and mitral regurgitation associated with multiple organ failure. Postsurgical cultures of arterial blood were repeatedly positive for C. glabrata, and therefore fluconazole was administered either intravenously or orally at a dose of 400 mg/day for 46 days. During that time the signs of inflammation including fever such as an elevated white blood cell count and the presence of C-reactive protein (CRP) all improved while the blood cultures became negative. Fluconazole is thus considered to be effective in treating PVE caused by C. glabrata. When administering this treatment, it is also important to monitor the patient's renal and liver function.

Crystal adherence to urinary catheter materials in rats

Crystal adherence to the surfaces of indwelling urinary catheter materials was investigated by scanning electron microscopy and immunofluorescence method. Small sterile disks were inserted into the rat bladder transvesically. Crystals were frequently associated with fibrillar material, some of which was believed to be fibrin. Increases in fibrillar materials were paralleled by increases in crystal adherence. On the other hand, a decrease in the amount of fibrin adhering to the surfaces of heparinized material, resulting in a decrease in the quantity of encrusting deposits on these materials, was found as compared with other catheter materials, including latex, silicone and nonheparinized material. These findings suggest that early adherence of fibrin to the surfaces of indwelling urinary catheter materials plays an important role in the development of crystal adherence and encrustation on catheter materials. It is also suggested that heparin inhibits the adherence of fibrin, resulting in decreased encrustation on the surfaces of the heparinized material.

Erythrocytosis complicated by multiple paraganglioma

We report the case of a 22-year-old woman with onset of erythrocytosis at the age of 9 years. Endocrinological and radiological examinations revealed an elevated catecholamine level and the presence of multiple abdominal tumors. After the removal of the tumors, the catecholamine level normalized, whereas erythropoietin remained at the same level and erythrocytosis persisted. The tumor lysate contained considerable amounts of catecholamine but not erythropoietin. Moreover, no erythropoietin mRNA was detected in the tumor by in situ hybridization. These data suggest that this paraganglioma did not produce erythropoietin. A review of the literature showed the existence of patients with early-onset erythrocytosis complicated with paraganglioma, whose erythrocytosis was not relieved even after the resection of paraganglioma.

Association between blood polychlorinated biphenyl concentration and serum triglyceride level in chronic "Yusho" (polychlorinated biphenyl poisoning) patients

The association between blood polychlorinated biphenyl (PCB) concentration and serum triglyceride level was investigated in 259 "Yusho" patients (PCB poisoning) who underwent health examinations for Yusho in 1988. Geometric means of PCB and triglyceride were 3.84 ppb (95% confidence interval: 3.54-4.17) and 114.3 mg/dl (106.6-122.6), respectively. Both correlation and multiple regression analyses showed a weak but statistically significant correlation between these two variables. The mean triglyceride level adjusted for age and sex was then calculated for comparison among four PCB levels, using analysis of covariance. This indicated a progressive increase with increasing PCB: 98.36, 117.78, 117.84, and 127.65 mg/dl at < 2.7, 2.7+, 4.1+, and 6.1+ ppb, respectively (F = 2.01, P = 0.113). Comparing PCB levels, the difference in adjusted mean triglyceride levels was marginally significant between the first and second (P = 0.088), and the first and third quartiles (P = 0.066), and reached significance between the first and fourth quartiles (P = 0.021). Thus, a weak but significant association between blood PCB and serum triglyceride was observed in the patients 20 years after exposure, although their blood PCB and serum triglyceride were relatively close to the normal levels.

Ureaplasma urealyticum in the urogenital tract of patients with chronic prostatitis or related symptomatology

To elucidate the role of Ureaplasma urealyticum as a causative organism in chronic prostatitis we investigated its incidence in the urogenital tract in 131 chronic prostatitis patients and 120 prostatodynia patients; the presence of common bacteria or Chlamydia trachomatis was also recorded. According to the 4-glass localisation test, U. urealyticum (> or = 10(3) ccu/ml) was isolated from the prostates of 16 prostatitis patients and 2 prostatodynia patients; 5 of these prostatitis patients (but neither of the prostatodynia patients) had other bacteria in specimens after prostatic massage. Thus U. urealyticum was the sole organism isolated from the prostates of 11 prostatitis and 2 prostatodynia patients, which suggests that it is an aetiological agent in some cases of chronic non-bacterial prostatitis.

An experimental model of ascending pyelonephritis due to Candida albicans in rats

We developed a new experimental model of ascending Candida pyelonephritis in female rats with leukopenia and vesicoureteral reflux. Rats were treated transperitoneally with cyclophosphamide (200 mg/kg) to induce leukopenia 3 days before and transurethrally with diluted acetic acid solution to induce vesicoureteral reflux 1 day before inoculation of Candida albicans strain, ATCC 10259 (containing 10(7) cells). Microscopy revealed acute pyelonephritis in which Candida cells invaded from the fornix and/or papilla into the medulla within 3 days after inoculation. Between 7 and 28 days after inoculation, chronic pyelonephritis reached the cortex. The incidence of pyelonephritis increased gradually and was approximately 80% after 7 days. Candida colony counts of bladder urine specimens obtained by direct puncture were significantly greater in rats with pyelonephritis extending into the parenchyma than in those with pyelonephritis located along the pelvis (p < 0.01). These results suggest that this rat model shows the characteristic feature of ascending pyelonephritis due to C. albicans and that the severity of Candida pyelonephritis can be estimated from Candida counts of bladder urine.

Diagnostic value of determination of serum mannan concentrations in patients with candiduria

The diagnostic value of determination of serum mannan levels was studied in 41 patients with candiduria and 20 control patients without candiduria. The patients with candiduria comprised 18 asymptomatic afebrile patients (group 1) and 23 febrile patients with suspected Candida pyelonephritis (group 2). Mannan antigenemia (> or equal to 0.5 ng/ml) was detected in 14 patients in group 2, this rate being significantly higher than the rate of four patients in group 1 (p < 0.05) and none in the control group (p < 0.01). Serum mannan levels decreased gradually and became undetectable in six patients in whom therapy with an anticandidal agent was effective. Determination of serum mannan levels may be a useful parameter in diagnosing Candida pyelonephritis and deciding on effective treatment.

Tranexamic acid reduces blood loss after cardiopulmonary bypass

To evaluate the effect of tranexamic acid (TA) on blood loss after cardiopulmonary bypass (CPB), 157 patients who underwent elective valve replacement operations were studied, with one group of 90 patients receiving tranexamic acid (Group TA) and 67 patients serving as the control group (Group N). In group TA, 50 mg/kg of tranexamic acid was administered just before and after CPB, and every 90 minutes during CPB. The activated coagulation time was maintained at more than 450 seconds during CPB in both groups. There was no significant difference in the CPB time between the groups (163 +/- 32 min in group N and 152 +/- 38 min in group TA:NS). The time required for hemostasis was shortened in group TA, which resulted in a shorter operation time (6.7 +/- 1.5 hrs vs 6.0 +/- 1.5 hrs in group N and group TA, respectively: p = 0.006). The amount of chest tube drainage within 12 hours after surgery was significantly reduced (225 +/- 129 ml vs. 180 +/- 118 ml in group N and group TA, respectively: p = 0.026). The chest tube was able to be removed earlier in group TA, and the total blood loss was significantly smaller in group TA (402 +/- 292 ml) than in group N (631 +/- 609 ml; p = 0.004). The authors thus conclude that antifibrinolytic therapy during CPB with tranexamic acid reduces postoperative blood loss, and shortens the operation time due to an improvement in hemostasis.

[Local recurrence of non-functioning adrenocortical carcinoma 14 years following surgical treatment: a case report]

A 76-year-old woman with a complaint of left flank pain was referred to our department for extensive examination and treatment. In 1976, she had undergone transperitoneal left adrenalectomy and nephrectomy under a diagnosis of left adrenal tumor. The surgical specimen had histologically been diagnosed as adrenocortical carcinoma. There have been no physical or endocrinological abnormalities. Computed tomogram, magnetic resonance imaging and angiogram revealed a retroperitoneal multiple hypervascular tumor with a non-homogeneous inner density. On January 16, 1991, a transperitoneal resection of the tumor with splenectomy and partial pancreatectomy was performed under a diagnosis of local recurrence of non-functioning adrenocortical carcinoma. The specimen was histopathologically diagnosed as low grade adrenocortical carcinoma based on 3 mitoses/50 hpf. From the reference study, this was thought to be the second case of late recurrence adrenocortical carcinoma.

Pharmacokinetics of temocapril and enalapril in patients with various degrees of renal insufficiency

Temocapril is a novel ACE inhibitor that is cleared via dual excretion routes in humans. Borderline or mildly hypertensive patients with normal renal function [group 1, creatinine clearance (CLCR) > 70 ml/min (4.2 L/h), n = 12], moderate renal impairment [group 2, CLCR 30 to 70 ml/min (1.8 to 4.2 L/h), n = 12] or severe renal impairment [group 3, CLCR < 30 ml/min (1.8 L/h), n = 12] received a single oral dose of either temocapril 1 mg (n = 6, each group) or enalapril 5mg (n = 6, each group). These 2 drugs gave similar values for the area under the plasma concentration-time curve (AUC) of the active diacids. The maximum plasma concentration of enalapril diacid was increased 2- and 6-fold in moderate and severe renal impairment, respectively, whereas that of temocapril diacid was not altered. The AUC of enalapril diacid increased 13-fold at CLCR values < 30 ml/min, but that of temocapril diacid increased only 2-fold. The duration of plasma ACE inhibition due to enalapril was greatly prolonged by the impairment of renal function, whereas that due to temocapril was affected very little. Urinary recovery of temocapril diacid was decreased markedly in patients with severe renal dysfunction, most probably because the diacid was excreted through the biliary route. On the other hand, urinary recovery of enalapril diacid remained fairly high even in patients with severe renal impairment, because of extremely high plasma diacid concentrations resulting from the lack of biliary excretion. These observations suggest that temocapril is beneficial in the treatment of hypertension in patients with severely impaired renal function.

Trans-ventricular septal defect approach for resection of accessory mitral valve tissue

Accessory mitral valve tissue is a rare cause of left ventricular outflow tract obstruction, which can be difficult to recognize. Surgical resection by the conventional transaortic approach with or without left atriotomy is extremely difficult in infants with a small aorta. When a ventricular septal defect is present, it may be the best way to approach the accessory mitral valve tissue, because the ventricular septal defect is located just in front of it. Five infants underwent resection of accessory mitral valve tissue together with repair of other intracardiac malformations. In 3 infants, resection of accessory mitral valve tissue was easily performed through the ventricular septal defect, which required enlargement in 2 patients.

Bacteremia resulting from prostatic surgery in patients with or without preoperative bacteriuria under perioperative antibiotic use

We investigated the source of organisms detected in blood specimens obtained during and immediately following prostatic surgery under perioperative antibiotic use, as related to the results of cultures of preoperative urines and prostatic tissues. Ninety patients with benign prostatic hyperplasia were studied. The incidence of bacteremia was 28.9%: 53.7% in patients with preoperative bacteriuria and 8.2% in those without bacteriuria, a significant difference (p < 0.01). Of these bacteremic patients, 5, who had preoperative bacteriuria, developed septicemia. Bacteremia developed more frequently in patients with positive than in those with negative prostatic cultures; this difference was significant (p < 0.05). The species in 80.8% of the isolates from blood specimens were identical with those isolated from preoperative urines, and the species in 53.8% were identical with those from prostatic tissues. These results indicate that in patients with urogenital infection, especially bacteriuria, septicemia can result from prostatic surgery even under perioperative antibiotic use. The incidence of postoperative bacteriuria was approximately 20% in the preoperative nonbacteriuric patients regardless of the duration of chemoprophylaxis.

Inhibition of nitric oxide formation in the nucleus tractus solitarius increases renal sympathetic nerve activity in rabbits

It has been shown that nitric oxide (NO) is synthesized in the central nervous system as well as in vascular endothelial cells. However, the physiological role of NO in cardiovascular regulation by the central nervous system remains unclear. This objective of this study was to examine the possibility that NO plays a role in neural transmission in the nucleus tractus solitarius (NTS) and thus contributes to control of sympathetic nerve activity in rabbits. We examined the effects of NG-monomethyl-L-arginine (L-NMMA), an inhibitor of the formation of NO from L-arginine, microinjected into the NTS on arterial pressure (AP), heart rate (HR), and renal sympathetic nerve activity (RSNA). L-NMMA increased AP and RSNA in rabbits with intact as well as denervated sinoaortic baroreceptors and vagi. L-NMMA increased HR only in rabbits with sinoaortic denervation and vagotomy. Pretreatment with L-arginine microinjected into the NTS, which did not alter baseline AP, HR, and RSNA, prevented the increases in AP and RSNA evoked with subsequent L-NMMA. Pretreatment with D-arginine did not alter the effects of subsequent L-NMMA injections into the NTS. The gain of arterial baroreflex control of RSNA assessed by the slope of the regression line relating changes in AP and those in RSNA caused by intravenous phenylephrine or nitroglycerin did not differ before and after microinjections of L-NMMA. L-NMMA microinjected into the area postrema did not alter AP, HR, or RSNA. These results suggest that in rabbits NO is involved in the mechanism in the NTS that mediates tonic inhibition of RSNA.(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous passage of upper urinary tract calculi in relation to composition

The composition of 2,755 calculi obtained from the upper urinary tract (1,409 by spontaneous passage and 1,346 by urological procedures) was analyzed using an infrared spectrophotometer, and the spontaneous passage rate was investigated in relation to the composition as well as other variables, such as stone size, and patient age and sex. Mixed stones of calcium oxalate and calcium phosphate were most frequently found, followed by those of calcium oxalate. The mean size (the maximum diameter) was largest in struvite stones and smallest in calcium oxalate ones. The sizes of stones from women were significantly larger than those from men (p < 0.01). As expected, the stone passage rates were inversely related to increasing stone size. The size of 55.6% of the stones passed was < or = 5 mm, and that of 96.6% of the stones < or = 10 mm.