(Purpose) To investigate the function of the hypothalamic-pituitary-testicular axis in testicular germ cell tumors, we evaluated gonadotropin responses to gonadotropin-releasing hormone (Gn-RH), semen quality, and serum levels of sex steroid hormones in patients with testicular cancer. (Patients and Methods) Basal serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and human chorionic gonadotropin-β (hCG-β) were measured before and after high orchiectomy in 20 patients with germ cell tumors of the testicle (9 with seminoma and 11 with nonseminomatous tumor). Semen quality and basal serum levels of testosterone, free testosterone, and estradiol were measured before orchiectomy. The Gn-RH test was performed before orchiectomy in all patients and after orchiectomy in patients without detectable gonadotropin levels in pre-operative serum samples. Gonadotropin levels were measured at 0, 30, 60, 90, and 120 minutes after intravenous injection of 100μg of luteinizing hormone-releasing hormone (LH-RH). (Results) Serum gonadotropin concentrations were not detectable in 6 of 8 (75%) men with hCG positive tumors or in 4 of 12 (33.3%) men with hCG negative tumors before orchiectomy. Before surgery, 10 men without detectable gonadotropin levels showed complete suppression of the LH and FSH responses to LH-RH and 10 men with detectable gonadotropin levels showed significant increases in the LH and FSH responses (p<0.01) at 30 minutes. After surgery, the Gn-RH test was performed in 9 men without detectable gonadotropin levels prior to surgery. Seven of these 9 men exhibited significant increases in the LH and FSH responses (p<0.01) at 30 minutes while no response to LH-RH before or after surgery was seen in 2 men with detectable serum hCG-β. We observed a significantly lower sperm density (median 7.5×106/ml, range 0.4 to 17.8) in men with hCG positive tumors than in men with hCG negative tumors (median 33×106/ml, range 0 to 103) (p<0.002). Although testosterone levels did not differ significantly in men with hCG positive tumors and men with hCG negative tumors, free testosterone levels were significantly higher in men with hCG positive tumors (median 28.4ng/ml, range 8.5 to 39.8) compared with men with hCG negative tumors (median 18.7ng/ml, range 4.9 to 24.1) (p<0.002). Estradiol levels were significantly increased in men with hCG positive tumors (median 44pg/ml, range 26 to 110) compared with men with hCG negative tumors (median 33.5pg/ml, range 10 to 87) (p=0.002). (Conclusion) The present findings indicate that serum hCG producing testicular cancers are associated with a complete suppression of the gonadotropin response to Gn-RH at the pituitary level, resulting in an inhibition of LH and FSH secretion, and also that serum hCG secreted by testicular cancers may suppresses spermatogenesis and may stimulate androgen and estradiol production by the testes. Since suppressed serum gonadotoropin levels are found in men with hCG non-producing testicular cancers, other factors derived from the tumor may cause downregulation of the gonadotropin response to Gn-RH.
(Objectives) Risk of having fetus affected with neural tube defects can be reduced by maternal periconceptional folic acid supplementation. The purpose of the present study is to investigate how folate is taken from diets and to measure plasma folate concentrations. (Subjects and Methods) A total of 222 women comprising 5 groups, i. e., healthy women, mothers of myelodysplastic patients, pregnant women, myelodysplastic patients, nurse students, participated in our study. Food frequency questionnaires kept 3 days were analyzed based on the 5th standard table of food composition in Japan. Plasma folate concentrations were measured by means of chemiluminescent immunoassay method. Changes in plasma folate concentrations and possible adverse effects following the folic acid supplementation for 16 weeks were also investigated. (Results) The dietary intake of folate, plasma folate concentration and energy intake averaged 293μg/day, 8.1ng/ml and 1, 857Kcal, respectively, among the subjects. Pregnant women took the largest amount of folate from diets and demonstrated the highest plasma folate concentration among the groups. The dietary folate in myelodysplastic patients and nurse students was significantly lower compared to that of healthy women. The Recommended Dietary Allowance of folate was not fulfilled in 22% of non-pregnant adult women and 72% of pregnant women. The dietary folate was mainly taken from the 3rd food group but the 4th group of food was consumed most. Mean folate intake was significantly correlated with circulating concentrations of serum folate (p=0.012 r=0.186). The consecutive administration of 400μg supplements for 16 weeks increased a baseline plasma value of 8.7ng/ml to 32.6 but fell down rapidly to 17.3 24 hours later without any adverse effects. (Conclusions) The dietary folate and serum folate concentrations averaged 293μg/day and 8.1ng/ml, respectively. The former is the first report based on the 5th standard table of food composition in Japan. Majority of pregnant women took less dietary folate than what recommended by the government. Those who are capable of becoming pregnant are recommended to consume much of the 3rd food group and those who are planning to become pregnant are recommended to take 400μg of folic acid supplements from 4 weeks before to 12 weeks after conception.
(Purpose) To evaluate psychometric properties of the Japanese version of International Prostate Symptom Score (IPSS) and BPH Impact Index (BII). (Methods) The translated IPSS and BII questionnaires were administered to 103 patients with benign prostatic hyperplasia and 23 asymptomatic men. In 82 patients the questionnaires were repeated 2 weeks later to examine reproducibility. Further 2 weeks later 21 out of 82 patients responded to the questionnaires asking symptoms during the last week rather than during the last month. To evaluated responsiveness the questionnaires were repeated after treatment in 22 patients. Internal consistency, construct validity and criterion validity were examined by proper statistic methods. (Results) Reproducibility was good to excellent with weighted kappa more than 0.62 for all items. It was not significantly affected by age, symptom severity, institution type, or whether the patients were asked symptoms during the last week or during the last month. Internal consistency was also good with Cronbach's α more than 0.83. Principle component analysis identified 2 components in IPSS and a single component in BII, with all the items contributing to the first component. Most items had significant correlation with external criteria including maximum flow rate, residual urine volume or prostate volume. The scores of patients were clearly larger than asymptomatic men and obviously reduced after receiving therapies. (Conclusion) Japanese translations of IPSS and BII were shown to be reliable, valid and onedimensional instruments in the Japanese patients. They would be equivalent to the original English questionnaires.
Mucinous adenocarcinoma of the prostate is extremely rare and its biological behavior is not well known. We report a case of mucinous adenocarcinoma of the prostate which stained positively for prostate specific antigen (PSA) and negatively for carcinoembryonic antigen (CEA) on immunohistochemical study. Our case contained conventional adenocarcinomas and no signet-ring cells. Thirty two cases of mutinous adenocarcinoma of the prostate which performed on immunohistochemical study of both PSA and CEA, including our case, were reviewed. 17 of the 23 cases of immunoreactive to PSA contained conventional adenocarcinomas, and 3 of the 10 cases of immunoreactive to CEA contained them, respectively. The 6 cases of immunoreactive to CEA only contained signet-ring cells. It indicated that there seemed to be the two types of mucinous adenocarcinoma of the prostate, the one which stained positively for PSA was the subtype of conventional adenocarcinomas, and the other which stained positively for CEA and negatively for PSA was derived from the intestinal metaplasia with atypia of the prostatic urethra.
We report a patient whose irritable bladder symptoms following Bacillus Calmette Guerin (BCG) instillation were satisfactorily treated by steroid administration. A 59-year-old male had undergone transurethral resection for the bladder carcinoma recurred three times. The histopathological examination revealed the tumor as transitional cell carcinoma, G1 to G2, and pTa. Subsequently an instillation of 80mg BCG into the bladder was planned 8 times every 7 days. After the 5th instillation he presented with gross hematuria, painful micturition, pollakisuria, urgency and reduced bladder capacity of 15ml. The dose was reduced to 40mg and another 3 instillations were accomplished. Since conventional treatments of anti-cholinergics, analgesics and epidural anesthesia were of little help for the subjective symptoms, he was put on the steroid pulse therapy 2 weeks after completion of the BCG regimen. The treatment gradually improved the subjective symptoms and increased the bladder capacity up to 160ml. In conclusion, we believe that the steroid pulse therapy deserves considering in the early stage of irritable bladder symptoms following BCG instillation.
We report a case of 50-year-old man with high flow priapism after blunt perineal trauma. Patient evaluation included intracavernal blood-gasometry, cavernography, color flow Doppler sonography, and internal pudendal arteriography. Although conservative treatment had been tried by an α-adrenergic agent, temporary effect was only obtained. We could successfully treat the priapism by percutaneous embolization of the left internal pudendal artery with autologous blood clot and Gelatin. 3 months after the embolization, erectile function of the patient recovered. High flow priapism as reported to date in the literature is also briefly reviewed.
We report on our experience in telementoring during laparoscopic adrenalectomy. An experienced laparoscopic surgeon supervised a less experienced surgeon from a control room about 100 meter away. Mentoring was accomplished over a fiber optic cable employing real-time video imaging, two-way audio communication, OES ImageTrac Video SystemTM used to control the laparoscopic image, and a telestrator. The patient was a 52-year-old male with primary aldosteronism due to a left adrenal adenoma 2cm in diameter. The procedure was successfully performed in 195 minutes with minimal blood loss. The patient recovered without complications and returned home on postoperative day 7. As broadband telecommunication expands, telementoring will become an important method for the training and supporting of laparoscopic surgery.