(Background) The present study was designed to reveal the possible use of transrectal sonography (TRS) and transperineal color Doppler flow imaging in predicting intrapelvic venous congestion syndrome (IVCS), as evaluated by three dimensional magnetic resonance venography (3D-MRV). (Methods) Thirty-one patients with prostatodynia and eleven control men were enrolled in this study. The diagnosis of IVCS was made based on the findings by 3D-MRV, such as the dilation of the prostatic capsular vein, the dilation of the pudendal plexus, the interruption of the internal pudendal vein and the dilation of the plexus behind the bladder. The prostatic capsular vein was observed ultrasonically as “sonolucent zone (SZ)”, and the maximum width of SZ was measured on sonograms. Transperineal color Doppler flow imaging was used to detect blood flow images of the prostatic capsular vein. The maximum velocity of it was also measured on sound spectrogram. (Results) IVCS was confirmed in 29 cases (IVCS group) and the other 13 cases were regarded as non-IVCS group. IVCS was recognized much more frequently in patients with prostatodynia than in controls (87% vs 18%, p<0.0001). The maximum width of SZ was 2.4mm (mean) in non-IVCS group, compared to 4.4mm in IVCS group (p<0.0001). The cutoff value of 3.0mm for the maximum width of SZ showed as high as 86% of sensitivity for the detection of IVCS. The maximum velocity of retrograde venous flow during Valsalva's maneuver in IVCS group (mean 14.4cm/s) was faster than non-IVCS group (mean 7.1cm/s, p<0.05). The cutoff value of 10cm/s for the maximum retrograde venous flow velocity showed as high as 69% of sensitivity for the detection of IVCS. (Conclusions) Both TRS and transperineal color Doppler flow imaging were usefull as a predictor for IVCS.
(Background) Endothelin is a recently discovered peptide with strong vasoconstrictive effects which is of potential relevance in the development of renal hypertension and renal failure. It is secreted by endothelial cells in response to ischemia, endothelial lesions and inflammatory or traumatic processes. Endothelin level after extracorporeal shock waves, effects of renal function and blood pressure were examined in rats. (Methods) Changes of plasma endothelin-1 (ET-1) levels after extracorporal shock waves were studied by applying 500 shock waves to both kidneys in Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR). Plasma ET-1 was measured before shock wave exposure and every thirty minutes up until 2 hours, then at 12 hours and 24 hours after shock wave exposure by specific sandwich enzyme immunoassay (EIA). Findings were then compared with those from the control group. Mean arterial pressure (MAP), glomerular filtration rate (GFR) and renal plasma flow (RPF) in rats were measured before shock wave exposure and every thirty minutes up until 2 hours after shock wave exposure, moreover maked evaluation when ET-1 specific antibodies were administered intravenosly into WKY and SHR. (Results) Plasma ET-1 was significantly increased in WKY (n=6) and SHR (n=7) after shock wave exposure as compared with that in the control group (p<0.05). In SHR (n=6), GFR temporarily decreased at 60min but RPF remarkably decreased and renal vascular resistance (RVR) increased at 30-20min after shock wave exposure (p<0.05). However, infusion of ET-1 specific antibodies into SHR curbed change in those parameters, increased GFR and RPF at 60-120min after shock wave exposure (p<0.05). In WKY (n=5), RPF temporarily decreased and RVR slightly increased, infusion of ET-1 specific antibodies curbed change in those parameters. MAP in SHR slightly increased at 30 min after shock wave exposure, but there was no significant change in WKY. (Conclusion) These results suggest that plasma ET-1 levels elevated in both strains and ET-1 influenced renal function after extracorporeal shock waves, and that SHR is more sensitive to ET-1 in comparison with WKY.
(Abstract) we studied image cytometric DNA analysis of bladder tumors to evaluate malignant potentials of bladder tumors. (Methods) Thirty nine samples were obtained by TUR from 37 patients. Nuclear DNA content of all samples were measured by image cytometer and were determined ploidy pattern by DNA histogram. (Results) Of 39 TCC non-diploid pattern was recognized in 50% of grade 1 cases, 73% of grade 2 cases and 100% of grade 3 cases. DNA ploidy was strictly correlated with histological grading in TCC. DNA non-diploid pattern was present in 67% of papillary tumors, 87.5% of non-papillary tumors and 100% in CIS. In diploid pattern 2 of 7 cases with grade 1 and 2 of 4 cases with grade 2 recurred. In non-diploid pattern 1 of 4 cases with grade 1, 4 of 10 cases with grade 2 and 4 of 6 cases with grade 3 recurred. There was no significant correlation between diploid and non-diploid pattern in grade 1, 2, 3. (Conclusion) Image cytometric DNA analysis may be useful in addition to the classic and prognosistic parameters of stage and grade, especially in TCC. The differences between image analysis system and flowcytometric analysis for DNA measurement were discussed.
(Background) Angiogenesis plays an important role in the growth of solid tumors. The objective of this study is to investigate the relationship between microvessel density and mRNA measurement for vascular endothelial growth factor (VEGF)as well as the kinase domain receptor (KDR) in renal cell carcinoma (RCC). (Methods) From 1992 to 1994, expression of mRNAs of VEFG, KDR and microvessel count by Factor VIII immunohistochemical staining were examined in 22 cases of RCC. (Results) Northern blot hybdridization demonstrated that 18 tumors (82%) expressed a higher level of VEGF gene than corresponding normal renal tissues (T/N>1) and that the expression of VEGF gene in the tumors correlated well with that of KDR gene (r=0.780, p=0.001). Most of the tumor cells positively reacted to immunohistochemical staining for VEGF, but all of the normal renal tissue elements did not. RT-PCR analysis revealed that mRNAs of VEGF expressed in the tumors were of soluble subclasses. The mean number of microvessels (<50 micrometers in diameter) in the tumors was 62.7+/-39.1/mm2 (range 13.7-133.1) and significantly correlated with the expression of VEGF gene (r=0.636, p=0.001). (Conclusions) The results indicate that RCC cells actively produce soluble VEGF and strongly suggest that VEGF and its receptor KDR cooperate to enhance the angiogenesis of this tumor.
(Background) Human renal adenocarcinomas do not adequately respond to cancer chemotherapy. Their multidrug resistance is mainly confered by the P-glycoprotein (P-gp). In this study, we analyzed effects of P-gp modulators on enhancement of anticancer activities against human renal cell carcinomas. (Methods) ACHN/ADM human renal adenocarcinoma cells with a high level expression of P-gp and 28 surgical specimens of renal cell adenocarcinomas were recruited. Adriamycin (ADM) and vinbiastin (VLB) were used as anticancer drugs, and verapamil (Ver) and cyclosporin A (CsA) were as P-gp modulators. The chemosensitivity was determined by the ATP-assay. (Results) Ver and CsA exhibited 1.5-fold and 6-fold increase, respectively, in the anticancer activities of ADM against ACHN/ADM cells. The anticancer activities of VLB were also enhanced by the modulators; 7-fold for Ver and 11-fold for CsA. In the chemosensitivity test of clinical specimens, the cancer for which the viability of the cells assessed by the ATP-assay was 50% or less than 50% after exposure to the anticancer drug with or without a P-gp modulator was defined as sensitive to the drug. Of the 14 clinical specimens exposed to anticancer durgs wihtout Ver, only 3 tumors and 1 tumor were sensitive to ADM and VLB, respectively, whereas with Ver, 6 tumors and 4 tumors were sensitive to ADM and VLB, respectively. Of the other 14 clinical specimens exposed to anticancer drugs without CsA, only 3 tumors and no tumor were sensitive to ADM and VLB, respectively, whereas, with CsA, 9 tumors and 6 tumors were sensitive to ADM and VLB, respectively. (Conclusion) This study indicate that Ver and CsA have effects on enhancement of the anticancer activities of ADM and VLB against human renal adenocarcinomas. The addition of Ver or CsA to chemotherapy will be a potential circumvention of P-gp-mediated multidrug resistance of renal cell adenocarcinomas.
(Background) In order to evaluate the precise effect of alpha-1 blocker on benign prostatic hyperplasia, symptomatic and urodynamic parameters were compared between before and after 4 week administration of tamsulosin hydrochloride (0.2mg/day) on 18 patients with untreated benign prostatic hyperplasia. (Methods) Symptoms were scored with international prostate symptom score (I-PSS) and urodynamic parameters were measured with pressure-flow study. (Results) The total score of I-PSS decreased significantly although the peak urinary flow rates, average flow rates or post-void residuals did not show a significant improvement after the treatment. On the other hand, the statistical analysis of pressure-flow studies revealed a significant decrease of vesical pressure at opening, at peak flow and at end of voiding after the treatment. In one patient, in whom the voided volume and urinary flow rate kept the same level throughout the treatment course, the total energy expelled from the bladder was calculated with the formula given as W=∫(pQ)dt. Both the detrusor work and vesical work (sum of detrusor contraction and abdominal straining) showed a marked decrease after the treatment. (Conclusions) It is suggested that alpha-1 blocker relieves overload of the detrusor and improves symptoms by reducing the energy demands for bladder emptying, even in case the flow rate does not improve. The urodynamic procedure including pressure-flow study is a useful means for not only diagnosing bladder outflow obstruction but also assessing overload or impaired contractility of the detrusor.
A case of ureteral malacoplakia in a hemodialysis patient is reported. A 64-year-old woman suffering from macrohematuria, was diagnosed as having a right ureteral tumor by means of computerized tomography and antegrade pyelography. Right nephroureterectomy with bladder cuff resection was performed. Pathological examination indicated malacoplakia; multiple Michaelis-Gutmann bodies were found. The patient did well postoperatively and was discharged without further complications. This case appears to be the twenty-first report of ureteral malacoplakia in the world.
This is a report of the occurrence of familial ectopic pheochromocytoma in two brothers, whose father had bilateral adrenal pheochromocytoma. Both brothers complained of hypertension. In the first case, a 22-year-old man presented with much higher than normal norepinephrine. Abdominal CT and chest CT scanning and 123I-MIBG scintigraphy revealed an extraadrenal tumor in the chest on the bilateral adrenal Brands. Bilateral adrenectomy was performed. In the second case, the 20-year-old brother was found to have an abdominal mass that was diagnosed as ectopic pheochromocytoma originating in the intra-abdominal paraaorta according to abdominal CT scanning and 131I-MIBG scintigraphy. The tumor was resected.
A rare case of CA19-9 producing tumor in undescended testis was presented. A forty-three year old man visited to our hospital with a chief complaint of left flank pain. Serum tumor markers (AFP, β-HCG, and CA19-9) were elevated. Abdominal CT scan demonstrated large solid mass with multilocular cysts were capsulated. The tumor resection was performed after 3 courses of CEB (Carboplatin, Etoposide, and Bieomycin) chemotherapy. Macroscopically, the tumor was consisted of necrotic mass and multilocular cysts. The tumor size was 25×8×5cm and weight was 1000g. Microscopically, the large part of tumor was necrotic due to chemotherapy, and the teratoma component which was consist of neural, musclar, and digestive tissue was seen in some area. In conclusion, this is a rare case of mixed germ-cell tumor in undescended testis located in abdomen.