A variety of vasoactive substances including biogenic amines, neuropeptide Y, somatostatin, enkephalin, ACTH, corticotropin-releasing hormone, growth hormone releasing hormone, vasoactive intestinal peptide, calcitonin, and atrial natriuretic factor have been extracted from intraadrenal and extraadrenal pheochromocytomas in men. Some of them appear to play an important role for the development of hypertension or crinical serious symptoms. However, informations on the molecular forms of other substances in pheochromocytomas are still limited, and precise amount of the peptides or hormones in the tumors has not yet been quantitated. Numerous in vitro or in vivo studies of this documented neoplasm over the years have been reviewed in this manuscript. Clinical analyses of early diagnosis, localization diagnosis, treatment of multiple endocrine neoplasia, preoperative and operative treatments are also evaluated in this paper. These informations will probably provide additional evidence for the multisecretory APUD cells of neural crest origin and will contribute the therapy in patients with pheochromocytoma.
Extracorporeal shock wave lithotripsy (ESWL) has been established as noninvasive treatment of choice for the great majority of upper urinary tract stones. However the management of staghorn stones in solitary kidney still deserves special consideration. We reviewed retrospectively 11 patients with staghorn stones in solitary kidney treated mainly with the Dornier HM-3 lithotripter during the period between December 1984 and December 1989 at the Sagamidai Hospital. The contralateral kidneys of the 8 patients were nephrectomized or nonfunctioning due to stone disease and those of 3 patients were nephrectomized due to tuberculosis. They were consisted of 6 males and 5 females with average ages of 60.0 years and 48.6 years respectively. The size of the stones ranged from 30×30mm to 85×40mm in KUB. ESWL was the first treatment for all the cases except for one patient a cystine stone. In that patient, ESWL was preceeded by percutaneous nephrolithotripsy (PNL). In three patients the treatment was successfully by ESWL alone without any obvious complication. In 6 patients percutaneous nephrostomy was required and in two patients PNL was performed as an auxiliary procedure. Seven patients developed high fever (over 38.5°C) and two of them became septic during the course of treatment. In five patients serum creatinine elevated over 2.0mg/dl, but returned to within normal limits postoperatively. Extracorporeal shock wave lithotripsy can play a major role in the patient of the staghorn stones in solitary kidney. However the patients have to be closely followed up a considerable length of time, because of large stone burden and resulting increased likelihood of ureteral obstruction due to fragments, consecutive impairment of renal function and systemic infection
We investigated the effects of intravesical instillation of BCG Tokyo 172 strain on patients with superficial bladder cancer and CIS of the bladder for tumor ablation and prophylaxis. This is the first controlled multicenter study for governmental approval of BCG Tokyo 172 strain for the treatment of superficial bladder cancer and CIS of the bladder. One hundred-fifty-seven patients (125 with Ta or T1, and 32 with CIS) were treated by 80mg of BCG diluted in 40ml of saline, once a week for 8 weeks. The dose and interval adopted in this multicenter study was determined by the previous Phase II study conducted by the same Study Group. Out of 125 superficial tumor Ta, T1, 83 (66.4%) showed complete disappearance of the tumor (CR) and 26 (20.8%) partial disappearance (PR), and out of 32 CIS, 27 (84.4%) showed CR and 2 (6.3%) PR. Among those patients showing CR, and PR who were treated with additional TUR-Bt, 98 patients were randomised for a controlled study of prophylactic BCG instillation. Prophylactic treatment consisted of 40mg of BCG diluted in 40ml of saline, monthly for 12 months. Forty-two patients were assigned to the treatment group, whereas the remaining 56 to the control group without any prophylactic instillation. Three cases showed tumor recurrence during the prophylactic phase. Twenty-five cases could not be treated for the whole course of phrophylactic instillation mainly due to bladder irritable symptoms. Recurrent free curves were compared till 1050 days after the initiation of the study. However, there was no significant difference between the two groups. The result was not different when the number of instillation was taken into consideration. Thus, initial BCG therapy for tumor ablation or short term prophylactic insitillation seemed to be enough for prophylaxis of superifical bladder tumor and CIS of the bladder.
Cryopreservation of semen from patients with oligozoospermia (sperm counts less than 20 million/ml) generally results in a severe decline in the percentage of motile spermatozoa after thawing in comparison with normozoospermia. We studied the effects of two metabollically active compounds, namely kallikrein and cafferine, on the survival of frozen-stored spermatozoa, in particular, from patients with oligozoospermia. A modified Ackerman's solution was used as the protective medium, and the specimens were frozen using a programmed freezer. We evaluated the post-thaw survival rate of spermatozoa by sperm counts on addition of agents. 1) When used the modified Ackerman's solution only, the post-thaw survival rate in the cases of oligozoospermia was significantly lower than that in the cases of normozoospermia. On the other hand, between these groups, there were no significant differences in the post-thaw activity rates of spermatozoa. 2) When added 1KE/ml kallikrein and 7.5mM caffeine (final volume) to the protective medium, the survival rate in the cases of oligozoospermia increased significantly, so that no significant differences were seen in the survival rates between the groups of oligozoospermia and normozoospermia. The effect of caffeine was better than that of kallikrein. 3) It was suggested that kallikrein and caffeine activated the non-motile live spermatozoa after thawing especially in the cases of oligozoospermia.
The Staphylococcis aureus in this study were isolated from 33 outpatients and 38 inpatients of the Department of Urology from August 1989 to April 1991. Twenty one patients (29.5%), three outpatients, had the MRSA type. Significant correlations were found between the incidence of MRSA infection and such factors as diabetis mellitus and the isolation of MRSA within 7 days of the administration of antibiotic agents. Out of 14 MRSA which were investigated for coagulase type, 9 were type VII. This indicates an outbreak of MRSA in the urological ward. Seven cases of MRSA and 5 cases of MRSA had high grade fever (over 38°C), but all patients experienced much relief by using susceptible antibiotic agents. Our study shows that the isolation frequency of MRSA has increased in urological field. Therefore, we think it is important to treat patients with MRSA infection adequately, especially when there are compromised hosts in the same room.
The relationship between sexual behavior and long-term stress in male Wistar rats was investigated. Rats were divided into two groups, one of which exposed to electrical foot shock for 1 hour a day for 10 weeks to create physical stress. The other group was exposed to the rats receiving shock to create psychological stress. Rats in both groups were placed in a compartment with a floor grid from which the foot shock might be derived. Rats in the psychological stress group were prevented from receiving foot shock by a plastic plate placed on the floor, but they were exposed to the response of the rats receiving foot shock. Sexual behavior tests were done 2, 4, 6, 8, and 10 weeks after starting the induction of stress. Rats in the physical stress group increased their sexual activity with exposure to long-term physical stress. On the other hand, rats in the psychological stress group temporarily increased their sexual activity, but then their sexual activity gradually decreased. Our experimental results suggest that long-term psychological stress reduces the sexual activity of male rats.
We have reported that sexual behavior of male rats is impaired by long-term psychological stress. We measured dopamine (DA) and its metabolites (3, 4-dihydroxyphenylacetic acid, DOPAC, and homovanillic acid, HVA) in the brain of rats which were exposed to the long-term stress. Our experiment was focused on the medial preoptic area (MPOA), which is perhaps the single most critical area of the brain mediating sexual behavior, the amygdala, the substantia nigra, the striatum, the nucleus accumbens and the cortex. In the MPOA, dopamine, DOPAC, and HVA decreased; in the substantia nigra and amygdala, dopamine and HVA decreased; and in the striatum and nucleus accumbens only HVA decreased after long-term psychological stress. In the cortex, however, no evidence of change was recognized. These changes indicate low activity of dopamine neurons which have an important role in male sexual behavior. Therefore, we suspect that exposure of male rats to psychological stress leads to a decrease in the activity of dopamine neurons, especially in the MPOA, amygdala, and substantia nigra, impairing their sexual behavior.
Retrospective analysis was carried out to evaluate the prognostic value of urinary cytology in bladder tumor patients. All of the 170 patients (107 superficial (<T2), 60 advanced (>T1) and 3 unknown (TX)), who were followed after their first occurrence, had histologically diagnosed transitional cell tumors. Recurrence rate for superficial cases was higher (p<0.05) when urinary cytology, either before or after the initial treatment, was positive than when negative. Patients with positive urinary cytology before the initial treatment proved to show poor prognosis compared to those with negative cytology (p<0.01), and many of the positive cases were with advanced cancer. Urinary cytology seemed to be indicative of the neoplastic potential of bladder tumor.
In Japan, it has not accepted that kidneys were hearvested from a heart beating cadaveric donor. We usually removed kidneys from a donor after a donor was in cardiac arrest. To minimize warm ischemia, we employed in situ perfusion of kidneys and new procedure alternate to evisceration technique in nephrectomy from a cadaveric donor. Our procedures for the hearvest of the kidneys from the cadaveric donor were presented and the clinical result of our series were reported. The kidneys was promptly perfused with chilled Ringer's lactate solution through double balloon catheter placed into the aorta, just after cardiac function ceased. Bilateral nephrectomy was performed through a long midline incision from just beneath the xyphoid bone to the pubic bone. Upon entering the abdomen, the small bowel and mesentery were retracted to the right and the posterior parietal peritoneum was incised over the great vessels and through the ligament of Treitz. The peritoneal incision was extended around the right colon so the bowel can be retracted upward and the right kidney was exposed. Then, the peritoneal incision was performed around the left colon to explore the left kidney. Both ureters were transsected as far down toward the bladder as possible. The in situ perfusion was stopped. Thereafter, the superior mensentric artery was transsected and the duodenum and the pancreas were retracted upward. The proxymal vena cava and aorta were transsected at a 2-3cm above the level of the left renal vein, and the distal vena cava and aorta at a 5-6cm an below the level of the left renal vein. The kidneys and the great vessels were removed in en block. Thirty eight kidneys were hearvested from 19 cadaveric donor by these procedures between September 1987 and December 1990. The mean time was 26min from the start of the incision to the removal of the kidneys. There was no injuries to the gastrointestinal tract. In only three kidneys the subrenal arteries were transsected near the aorta. In two kidneys, the subartery was ligated and the transsected artery was anastomosed to the main renal artery in another kidney. All kidneys were transplanted in 38 recipients. These results indicated that this operative procedure is useful in removing kidneys from a cadaveric donor.
We report here the favorable results of clinical application of 15-deoxyspergualin (DSG) as a rescue therapy for rejection episodes in kidney transplant recipients. DSG was discovered in Japan and was proved to be a novel immunosuppressant in various animal transplantation models. The immunosuppressive mechanism of DSG is unclear yet, but its point of action is supposed to be in the early immuno response to allogeneic stimulation without the regulation of cytokine production. We performed the administration of DSG in fifteen patients, who had rejection episodes, with a dosage of 3mg/kg/day or 5mg/kg/day for five days by drip infusion. In the group of recipients who had rejection episodes within six months after kidney transplantation, DSG proved effective on six out of seven acute rejection episodes and induced favorable remission. And in the group of recipients who had rejection episodes after six months since kidney transplantation, DSG proved effective on all of ten rejection episodes. There was not a difference of effectiveness in respect to the dosage of DSG. The side effect of DSG treatment was mainly leukopenia but in most cases these leukopenia was remitted just under careful observation. Some patients complained the sense of abdominal discomfort. But so far, we did not encounter serious or critical side effects and complications during all the time of progression. Another benefit was that DSG was able to reverse the rejection episode even in the patient who had already treated with anti lymphocyte globulin and/or anti CD3 monoclonal antibody OKT3. We concluded that the administration of DSG as a rescue therapy was not accompanied by the serious side effects and was most effective against acute rejection after kidney transplantation.
Deoxyspergualin (DSG), which is a new immunosuppressive drug developed in Japan, is expected to be an immunosuppressant for the treatment of rejection, because it has immunosuppressive action different from that of other drugs. In the present study we used DSG to treat renal allograft rejection of in total 17 cases; 6 cases with acute rejection, 8 with chronic rejection and 3 with acute on chronic rejection. We infused DSG very slowly over 3 hours at a dose of 3-7mg/kg/day for 5-7 days. Four cases (44.4%) with acute or acute on chronic rejection showed excellent response to DSG, three cases (33.3%) showed fair response and two cases (22.3%) did not respond at all. We also used DSG in patients with chronic rejection. In many of them, the increase in serum creatinine was suppressed. Ten of the total patients (58.8%) developed side effects including leukocytopenia, thrombocytopenia, numbness of the face etc. No patients needed discontinuation of DSG. From the above results, we think that DSG is a safe and effective drug to treat acute rejection. Furthermore, we could get the results which suggest that DSG is effective for the treatment of chronic rejection.
A congenital arteriovenous fistula (AV fistula) in the true pelvis is extremely rare, especially in males. We present a case of this disease with pollakiuria and intrarectal discomfort. Diagnosis was made by computed tomography and magnetic resonance imaging and confirmed by cine angiography. Because the AV fistula involved the bladder, prostate and rectum, ligation of the main feeding arteries was performed. He also had benign prostatic hypertrophy and was treated by conservative therapy because of a high risk of massive bleeding in surgical treatment.
An 83-year-old man came to our hospital complaining of asymptomatic gross hematuria. We found a subcutaneous tumor in his chest and an abdominal mass in his left upper quadrant. Laboratory data showed red blood cell count of 737×104/mm3 and hemoglobin level of 17.9g/dl. The serum erythropoietin level measured by radioimmunoassay was considerably high. He underwent left nephrectomy and tumor resection in the chest wall. Serum erythropoietin level became normal following surgery and erythrocytosis disappeared. Histological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 2. The erythropoietin levels of the extracts of the cancer tissue and the normal kidney tissue were 2430mU/g and 59.5mU/g, respectively. Lung, liver and bone metastases appeared four months after the operation and serum erythropoietin level increased again.