Biomedical subjects
Publications and source records attributed to A Terai.
A case of pheochromocytoma presenting as an acute abdominal emergency with shock is described. Shock was followed by transient hypertensive crisis and thereafter by spontaneous remission of clinical symptoms. The surgically removed tumor showed extensive necrosis.
A case of right adrenal pheochromocytoma was described which presented as an acute abdominal emergency and resulted in shock due to spontaneous rupture into the retroperitoneum. Spontaneous remission of clinical symptoms followed and the tumor was safely resected later. Scintigraphic imaging using 131I-metaiodobenzylguanidine clearly demonstrated the tumor when endocrinological examinations were within normal ranges.
We report a case of a benign fibroepithelial polyp of the lowermost ureter, which prolapsed into the bladder and was associated with a huge, impacted ureteral stone. The polyp was considered to have resulted from chronic irritation of the ureteral mucosa caused by the stone. Review of the literature showed that six out of 74 reported cases had concomitant stones but the polyp was apparently caused by the calculi in only one case.
A patient with a bifid pelvis and ureteropelvic junction obstruction of the lower system was managed successfully by endopyelopyelotomy. This percutaneous procedure consists of creation of an internal fistula between the 2 pelves by incision of the intervening tissue with an optical urethrotome. This procedure provided a satisfactory and reproducible result.
The duration of analgesia and the cardiovascular changes during anesthesia of spinal blockade with isobaric bupivacaine were examined in 36 patients between 21 and 75 years old undergoing percutaneous nephro-ureterolithotomy. Injection of 0.25% or 0.5% bupivacaine 3.0-4.0 ml through the L3-4 or L2-3 intervertebral space in the horizontal posture resulted in spread of hypalgesia to T6 in 30 patients and of analgesia to T6 in about a half of the patients. In six patients, another intrathecal injection of 2 ml of bupivacaine was performed because their analgesia level had been under T8. Although the operation took 32-141 min. (mean 77.7 +/- 27.5 min.), there was no case requiring exigent exchanging anesthesia for general anesthesia. The frequencies of the hypotension, bradycardia and nausea in spinal blockade with isobaric bupivacaine were not so different from those of the previous epidural anesthesia in 29 patients undergoing the same operation. Most of the cardiovascular changes in the spinal blockade with isobaric bupivacaine happened within 20-30 min. after intrathecal injection of bupivacaine. Spinal anesthesia with isobaric bupivacaine proved satisfactory for percutaneous nephro-ureterolithotomy.
Percutaneous and transurethral removal of renal and ureteral calculi was performed in 109 cases. Targeted calculi were successfully removed in 105 cases (96.3 per cent), but in five cases combined percutaneous and transurethral procedures were required. Although endourological stone removal resulted in low morbidity rates in many other series, some major complications have also been reported. They include arteriovenous fistula, colo-cutaneous fistula, nephro-duodenal fistula and ureteral avulsion. There were two severe complications in our early experience as well. In one case, a ureteral stenosis was found seven months after two sessions of percutaneous ultrasonic lithotripsy for an upper ureteral stone, and in the other case, a mid-ureteral avulsion was caused by ureteroscopic manipulation. Besides these, we experienced several minor pelvic and ureteral perforations which were easily controlled only by ureteral stent placement. Causes and management of ureteral complications in endourological treatment of renal and ureteral calculi are discussed.
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We report two cases of small renal cell carcinoma, which were incidentally detected by abdominal computed tomography (CT) and ultrasound. Both tumors were less than 15 mm in diameter and low grade, stage I lesions. Incidentally found renal cancer does not always indicate better prognosis. However, in selected patients with small tumors, surgical enucleation may be an acceptable method of treatment even if the contralateral kidney is normal. Renal screening should be a routine part of abdominal ultrasound. In our institution, ultrasound revealed incidental renal cancer in 0.035% of non-urologic patients.
Two cases of adrenal cysts are described. The first case is of bilateral adrenal cysts in a 44-year-old woman. It seems to be the first case of bilateral adrenal cysts in the Japanese literature. The second case is of a left adrenal cyst with sandy calcification in a 71-year-old woman presenting with asymptomatic gross hematuria. Several hormone levels in the cyst fluid were higher than in those in the plasma; cortisol and aldosterone in the first case, and cortisol in the latter. This finding suggests that the hormonal study of cyst fluid obtained by percutaneous needle aspiration under ultrasonic guidance is useful in the differential diagnosis of adrenal cyst from those arising from other organs.
A 35-year old man was hospitalized for left flank pain. IVP showed left non-visualizing kidney with multiple renal calculi. Selective renal arteriogram revealed avascular mass in the left upper pole. The upper calyx was irregularly distorted. Left nephrectomy was carried out. Grossly, the upper pole was replaced by whitish, firm and homogeneous tumor, which was 7 X 7 cm in diameter and protruded into the upper calyx. Histologically, the tumor was composed of both epithelial and mesenchymal components. The epithelial elements consisted of cysts and tubules, and the mesenchymal elements of loosely textured fibroblasts and smooth muscle cells. Other elements could not be identified. This case was diagnosed as renal hamartoma histologically resembling congenital mesoblastic nephroma of infancy. Congenital mesoblastic nephroma is rare in adults. Continued maturation may finally transform it either to benign mixed tumor as in our case or fibromatous tumor if stroma matures dominantly.
A case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively.
Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.
We report a case of transitional cell carcinoma of the renal pelvis arising in a pelvic kidney two years after resection of bronchogenic carcinoma. Primary cancer in a pelvic kidney has been rarely described and this is the second reported case of transitional cell carcinoma originating in a pelvic kidney and the first associated with recurrent lung cancer.
The safety and efficacy of transurethral microwave thermo-therapy (TUMT) for the treatment of symptomatic benign prostatic hyperplasia (BPH) have been demonstrated in the urological literature. Since a radiofrequency electromagnetic wave has deeper and more even transmission of heat to tissues than a microwave, we have developed a new prototype device for transurethral thermotherapy using a radiofrequency electromagnetic wave. The device consists of a microcomputer-controlled heat generator operating at 8 Mhz, a temperature monitoring system, a urethral cooling system and a urethral applicator and a rectal thermosensor probe. A balloon electrode encased in a specialized Foley catheter is connected parallel to twin plate electrodes on both sides of the pelvic region. An 8-MHz electromagnetic wave is directed to the prostate by means of capacitive coupling. The water coolant continuously perfused through the catheter allows high temperatures within the prostate while preserving the urethral mucosa. Heating experiment using agar phantom showed the hot spots to be distributed at 0.5-3 cm from the catheter surface. Heating experiment using canine prostates demonstrated that an intraprostatic temperature of > 48 degrees C could be achieved while the urethral and rectal temperatures had not exceeded 36 and 40 degrees C respectively. Histological examination immediately after the experiment showed the urethral mucosa to be preserved while coagulation necrosis of the periurethral prostate accompanied with congestion and hemorrhage of small blood vessels were observed at 5-8 mm from the urethra. The bladder and the rectum showed no gross alterations. Histopathological examination 10 days after the experiment revealed the intact urethral mucosa and mild mononuclear infiltration around the destroyed periurethral glands.(ABSTRACT TRUNCATED AT 250 WORDS)