(Purpose) Our purpose of this study was to evaluate the effect of a transdermal estradiol delivery system in postmenopausal women with confirmed pollakisuria and urinary incontinence. (Patients and Methods) We investigated 10 postmenopausal women, age 54-83 years, with pollakisuria and urinary incontinence but did not show distinct urological and/or neurological abnormalities. In this study, estradiol transdermal therapeutic system (Estraderm TTS® 2mg) alone were administrated for total of 8-week and this is observatinal, not randomized, blinded or controlled. A clinical evaluation were performed two times at before and after administration. (Results) In seven eligible cases, the severity of urinary incontinence was graded down in almost of them and the therapeutic effect on urinary incontinence was evaluated as “very effective” in 3 cases, “improved” in 2, “slightly improved” in 1 and “no change” in 1, respectively. In three eligible cases, the severity of pollakisuria was no change in all of them. (Conclusion) Thus, the estrogen supplement therapy was considered effective for postmenopausal urinary incontinence.
(Purpose) To determine the value of color Doppler ultrasonography (CDUS) in the diagnosis of acute scrotum. (Materials and methods) 10 patients referred to our hospital with acute scrotal pain were included in this study. All patients were evaluated with CDUS after the initial clinical examinations. Blood flow of the involved testis was compared semiquantitatively to that of the opposite testis. Patients with a diagnosis of testicular torsion by CDUS underwent surgical exploration. Patients with CDUS diagnosis of epididymitis were treated with intravenous antibiotics. (Results) Of the 10 patients evaluated, CDUS diagnosed 5 patients with testicular torsion and 5 patients with epididymitis. All cases of torsion were confirmed intraoperatively. 2 cases with no intratesticular blood flow on CDUS had necrotic testes and underwent orchiectomy with orchiopexy of the contralateral testes. A case with absent flow and 2 cases with decreased flow had bilateral orchiopexy. CDUS findings of normal or increased flow were present in all patients with epididymitis. No cases of testicular atrophy were encountered on long-term follow up in patients with epididymitis. (Conclusion) CDUS is helpful in detecting the perfusion of the testis as well as in getting anatomical information. CDUS is a very useful device which causes a minimal burden to the patient with acute scrotum. In most cases it will rapidly provides us the correct information although it may not be regarded as the definitive adjunct.
(Objective) Serum soluble interferon α/β receptor (s-IFN-receptor) levels were determined in renal cell carcinoma (RCC) patients to study the clinical significance of the measurement. (Subjects and Methods) S-IFN-receptor levels were measured in RCC patients (n=27) and healthy volunteers (n=22) by enzyme immunoassay technique. (Results) Significantly higher serum s-IFN-receptor levels were observed in RCC patients compared with the healthy volunteers (p<0.003). The high s-IFN receptor levels in the patients suggested seriousness and mal-prognosis of this disease. The 4-years survival rate of the higher level group (with the mean value of 2.7±1.7ng/ml or more) was 53.3%, while the lower level group's rate was 78.7% (Statistical analysis result by Logrank (Mantel-Cox) test; p=0.4289). (Conclusion) Further study in more subjects is required to determine the feasibility of the s-IFN receptor levels as a prognosis marker, since correlation between the prognosis and s-IFN receptor level was not clarified by this study result.
(Background) There are many controversies surrounding the management of ectopic ureteroceles (EUC). The aim of this study is to review our cases with EUCs and to show our policy of choice of treatments of EUCs. (Methods) The medical records of 39 patients with EUCs treated at Kobe Children's Hospital from 1978 to 1998 were reviewed retrospectively. Patients' age, affected site, presentation, treatment, and postoperative course were recorded. (Results) The age at presentation ranged from 0 month to 13 years (mean; 6 years). The left EUCs were found in 15 patients, the right in 17 patients, and the bilateral in 7 patients. The EUCs with duplicated system of the kidney were involved in 35 cases (42 kidneys) and single system in 4 cases (4 kidneys). The most common mode of presentation was urinary tract infection (n=24) followed by abdominal distention (n=6) and fetal ultrasonography (n=6). One patient presented with incontinence and in two patients EUCs were discovered incidentaly. Thirty-five cases (42 kidneys) were followed up over six months. In these cases diversion including nephrostomy and ureterostomy was performed in 5 kidneys, heminephrectomy and/or excision of the EUC and ureteral reimplantation in 8 kidneys, nephrectomy in 3 kidneys, pyeloureterostomy in 2 kidneys, excision of the EUC and ureteral reimplantation in 10 kidneys, and transurethral incision (TUI) of the EUC in 14 kidneys. After these treatments the second surgery was totally required in 15 kidneys (36%) including 7 kidneys in which TUI was performed. Furthermore, in two kidneys the third operation was performed. (Conclusions) Reoperation was required in about one-third of patients with ectopic ureteroceles. It is easy to perform TUI, however the rate to reoperation is high.
A 72-year-old man was referred to our department with the chief complaint of painless swelling of the left scrotum in May 1997. Left high orchiectomy was performed under the diagnosis of primary testicular tumor. Histological findings revealed non-Hodgkin's lymphoma (NHL) of diffuse, mixed type, B cells. No evidence of tumors in any other site was detected by further examinations. About 3 years and a month earlier, he had undergone right high orchiectomy and postoperative radiotherapy (inverted Y irradiation) and chemotherapy (CHOP 5 cycles) for a right testicular tumor whose histological findings were NHL of diffuse, large cell type, B cells. Metachronous bilateral primary malignant lymphoma of the testis is very rare and we discussed each tumor origin by using IgH gene (IgJHDNA) rearrangement as a tumor specific marker of B cell lineage malignant lymphoma. We discussed the clonality of IgJHDNA rearrangement using polymerase chain reaction (PCR) in each paraffin fragment diagnosed pathologically as NHL of B cell origin.
A 62 year-old man had been suffered from headache and left shoulder pain since March 1997. In November 1997, he visited our hospital complaining of work incapability, slow-moving and somnolence. Multiple nodular lesions were found in his brain and abdominal wall. Biopsy of the abdominal wall mass revealed small cell carcinoma/neuroendocrine cell carcinoma. Radiation therapy on brain and abdominal wall was done and these tumor nodules became decreased. However, recurrence and metastasis occured later and died at March 1998. The autopsy revealed the origin of these tumors was the prostate. The prostatic tumors revealed neuroendocrine cell carcinoma mainly, combining a portion of adenocarcinoma. Most parts of the metastatic tumors were neuroendocrine cell carcinoma. Only the seventh thoracic vertebral metastasis was bone-sclerosing metastasis of adenocarcinoma.