[Blood purification after kidney transplantation].
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Adult↗
Biomedical subjects
F Ikoma
Publications and source records attributed to F Ikoma.
Is hormonal therapy necessary in prepubertal boys with cryptorchidism?
Three hundred and twenty-eight prepubertal boys with cryptorchidism who had orchiopexy were reviewed in regard to the attachment of the gubernaculum. Normal attachment of the gubernaculum was found in only 19 out of 240 unilateral testes (8%), and in 12 out of 176 testes (7%) of 88 patients with bilateral cryptorchidism. Abnormal attachment of the gubernaculum was found in 307 out of 338 testes (91%). These data suggest that hormonal therapy for undescended testis may be effective in only 9% of the cases with cryptorchidism, and it cannot replace surgery.
Adolescent↗
A case of 17 alpha-hydroxylase deficiency with chromosomal karyotype 46,XY and high plasma aldosterone concentration.
A 15-year-old female case of 17 alpha-hydroxylase deficiency with 46,XY chromosomal karyotype is reported. High plasma aldosterone concentration (285 pg/ml) with low plasma renin activity (less than 0.1 ng/ml/h) and the absence of organs derived from Müllerian ducts with immature testes were recognized. Bilateral orchiectomy was done after hormonal control by the administration of dexamethasone. The basic characteristics, mechanism of high plasma aldosterone concentration, steroid modification of Müllerian inhibiting substance and rationality of castration in a case of 17 alpha-hydroxylase deficiency are discussed.
Adolescent↗
True hermaphroditism: pre- and postoperative evaluation of gonadal function and the necessity of endoscopic examination for the search of cervix uteri at an early stage of diagnosis.
Three previously unreported cases of true hermaphroditism are described and discussed with regard to their gonadal function and the value of endoscopic examination. All three patients showed a good response of serum testosterone to stimulation with human chorionic gonadotropin before gonadal biopsy. The third patient showed significant elevation of serum oestradiol level on stimulation with human menopausal gonadotropin at two years of age before operation. Endoscopic examination to search for cervix uteri at an early stage of diagnosis, and pre- and postoperative functional evaluation of the gonads by hormonal stimulation are emphasized.
Cervix Uteri↗
Caudal migration of the verumontanum.
The location anomaly of the verumontanum has not been described in the literature. We confirmed that the verumontanum was located either in the sphincteric or bulbous urethra in 61 of 477 patients with hypospadias (12.8%) through endoscopic examination and urethorgraphy. There was a patient with bilateral cryptorchidism who had distal location of the verumontanum. The patients with hypospadias and caudal migration of the verumontanum showed significantly low response of testosterone to human chorionic gonadotropin stimulation compared with normal controls. The incidence of caudal migration of the verumontanum was higher in the patients with a severe degree of hypospadias than in those with mild hypospadias. These results suggest that distal location of the verumontanum may be the result of an insufficient action of androgens during the period of critical sexual differentiation in the male embryo. We call this phenomenon caudal migration of the verumontanum, which seems to be a new clinical entity.
Abnormalities, Multiple↗
A seromuscular stripping method to create a nipple valve without metal stapling for continent urinary reservoir.
Urinary continence with a Kock or Mainz pouch is achieved by a nipple valve of the invaginated ileum which is usually fixed with metal staples. However, metal staples can cause various complications as a foreign body. The seromuscular stripping method, a new technique to create a nipple valve, was applied to 17 patients with bladder cancer in the construction of a continent urinary reservoir by the ileocolonic pouch (Mainz pouch). Metal staples were not used. The results were satisfactory except for 2 patients who became incontinent because of prolapse of the nipple in one and insufficient valve function due to ischemic change of the nipple valve in the other. Histology of the nipple valve from an autopsy case showed a good double layer nipple valve that functioned well to preserve continence.
Carcinoma, Transitional Cell↗
Evidence that a solubilizing agent has no effect on cyclosporine-associated hyperpotassemia.
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Castor Oil↗
[Congenital lower urinary tract obstruction and enuresis in children].
We reviewed enuretic children among patients with congenital lower urinary tract obstructions experienced in the Department of Urology, Hyogo College of Medicine during 16 years from 1974 to 1989. Among 612 patients with congenital lower urinary tract obstructions, 139 (22.7%) had enuresis nocturna and/or diurna. The incidence of enuresis was 24.7% with posterior urethral valve (77 cases), 50.0% with anterior urethral valve (6 cases), 23.8% with congenital bulbar urethral stenosis in boys (303 cases) and 19.9% with congenital distal urethral stenosis in girls (226 cases). Diurnal enuresis was more common in enuresis associated with congenital lower urinary tract obstructions than in usual enuresis. In urodynamic examinations, more than half of enuretic children with congenital lower urinary obstructions showed hyperactive detrusor activity. Treatment of congenital lower urinary tract obstructions through operation resulted in cure or amelioration of enuresis in about 80% of the patients. Enuresis associated with lower urinary tract obstruction or neurogenic bladder is sometimes called complicated enuresis and it is an important role of a urologist to differentiate complicated enuresis from simple enuresis.
Adolescent↗
[A case of malakoplakia of the kidney and urinary bladder].
A case of malakoplakia which co-existed in the kidney and the urinary bladder is reported. The patient was a 51-year-old female who had been suffering from asymptomatic macroscopic hematuria. Cystoscopic examination revealed multiple yellow-red nodules in the posterior and lateral wall of the bladder. Transurethral punch biopsy of the mucosa was performed and histopathological examination of the specimens revealed the diagnosis of malakoplakia. The laboratory data at admission were within normal limits except for slightly accelerated erythrocyte sedimentation rate. The culture of urine was negative. The cytology of urine was interpreted as Papanicolaou class I. Intravenous pyelography demonstrated filling defect of the left upper renal calyx, which was confirmed by retrograde pyelography. Computerized tomography showed dilatation of the left upper calyx. An exploratory operation disclosed that the upper calyceal neck was obstructed by several small nodular lesion, which were very similar to the lesions in the bladder. Because intraoperative pathological diagnosis of the frozen section was malakoplakia, partial nephrectomy was performed. Histopathological examination of the kidney and the bladder showed typical Michaelis-Gutmann bodies in the granulomatous lesions. Follow-up examinations 4 months after operation revealed some residual lesions in the bladder which were treated with bethanechol, but no recurrence in the kidney.
Bethanechol↗
[Treatment of 300 patients with bladder cancer].
From September 1973 to September 1989, 300 patients with bladder cancer were treated at the Department of Urology, Hyogo College of Medicine. They were 231 males and 69 females with an average age of 65.3 years old. The overall 5-year survival rate (Kaplan-Meier's method) was 64.7%. The 5-year survival rates were not different between male patients and female patients, or between patients with single tumor and patients with multiple tumors. Patients with vesical irritation symptoms had more unfavorable prognosis than patients with painless hematuria. Size and configuration of the tumors also affected the prognosis. Histological diagnosis was transitional cell carcinoma in 291 patients, squamous cell carcinoma in 7 patients, adenocarcinoma in one patient and undifferentiated carcinoma in one patient. In patients with transitional cell carcinoma, the 5-year survival rates according to histological grades were 93.5% for G1, 77.8% for G2 and 31.6% for G3. The 5-year survival rate according to clinical stage was 94.4% for Ta, 79.7% for T1, 66.7% for Tis, 46.1% for T2, 38.5% for T3 and 26.6% for T4. Transurethral resection of bladder tumor (TUR-b.t.) was performed in 208 patients as an initial operation and the 5-year survival rate in these patients was 78.6%. The 5-year survival rates for total cystectomy (52 patients), partial cystectomy (6 patients) and simple tumor resection (4 patients) were 51.9%, 25.0% and 37.5%, respectively. These findings suggest that superficial tumors (Ta, T1) can be controlled with TUR-b.t. but infiltrating tumors (T2, T3, T4) should be treated more vigorously with multidisciplinary approaches.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Urinary tract anomalies detected in prenatal diagnosis].
Advances and spread in ultrasonography in obstetrics have resulted in the increase in the number of reports of congenital anatomical anomalies that have been diagnosed prenatally. We present 56 patients with congenital urinary tract anomalies, which were found by prenatal USG. These anomalies included pelvi-ureteric junction stenosis in 19, multicystic kidney in 12, primary megaureter in 6, ureterocele in 4, posterior urethral valve in 3, polycystic kidney in 2, vesicoureteral reflux in 2, urogenital sinus anomaly in 2 and others in 4. There were 9 oligohydramnios: posterior urethral valve in 2, polycystic kidney in 2, bilateral multicystic kidney in 2, urogenital sinus anomaly in 2 and vesicoureteral reflux in 1. In the neonatal period, urological treatment was performed on 13 patients; indwelling catheter on 4, vesicostomy on 2, ureterocutaneostomy on 2, TUR cele on 2 and others on 3. Among the cases, 25 have been operated on after the various intervals of follow-up periods. Pyeloplasty was performed on 9 patients with pelvi-ureteric junction stenosis, total reconstriction on 4 with ureterocele, ureterocystoneostomy on 3 with megaureter and others on 9. There were 7 lethal cases; polycystic kidney in 2, multicystic kidney in 2, posterior urethral valve in 1, megaureter in 1 and urogenital sinus anomaly in 1. It seems likely that various kinds and increasing number of urinary tract abnormalities will be diagnosed through prenatal USG. It is now important to make a consensus for the timing and management of the therapy of these anomalies.
Female↗
[A case of infected urachal cyst in an 8-year-old boy].
An 8-year-old boy with infected urachal cyst presenting with macroscopic hematuria, pain on urination and high fever attack is reported. He had recurrent episodes of cystitis. At admission, a quail-egg sized solid tumor was palpated in the midline of his lower abdomen. The urine was infected. Ultrasonographic examination revealed an oval tumor 2 x 2.7 cm in diameter at the dome of the bladder with a thin funicular structure running toward the umbilicus. Cystoscopy revealed a round tumor covered with hyperemic epithelia. Transurethral biopsy revealed no malignant lesions of the epithelia. Partial cystectomy with excision of the funicular urachal ligament was performed. The pathological findings were consistent with persistent urachus with chronic inflammation. We reviewed 210 cases of infected urachal cysts reported in the Japanese literature.
Age Factors↗
Combined cisplatin and radiation therapy in patients with invasive bladder cancer.
Thirty-five patients with T2-T4 invasive bladder cancer were treated with combined cisplatin and radiation therapy. In 18 patients radical cystectomy was performed after the combined therapy. In the other 17 patients radical cystectomy could not be performed for various reasons. Pathological examination of the cystectomy specimens showed down-staging in 66.7% and no residual tumour in 33.3%. These results suggest a synergistic action of cisplatin and radiation. Side effects were not severe and were well tolerated. This combined therapy of cisplatin and radiation is very effective for invasive bladder cancer.
Adult↗
Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiography.
We report on a child with nutcracker phenomenon, which is a possible cause of intermittent gross haematuria of unknown origin. Early serial ultrasound examinations can demonstrate the lesions. The merits and demerits of conventional angiographic imaging are also discussed.
Aorta, Abdominal↗
Androgen receptor levels in patients with isolated hypospadias.
The binding of [3H]dihydrotestosterone (17 beta-hydroxy-5 alpha-androstan-3-one) to the androgen receptor was studied in 26 prepubertal boys with isolated hypospadias (no associated anomaly) using fibroblasts cultured from surgical specimens of hypospadiac penile skin and/or chordal tissue. Maximal binding capacities of androgen receptor for [3H] dihydrotestosterone in 10 patients with mild degree (2 glandular + 8 penile), 6 with severe degree (4 penoscrotal + 2 scrotal), chordal tissues of hypospadias (N = 10), and controls (10 endocrinologically normal boys) were, respectively, 11750 +/- 2410, 10720 +/- 2680, 16100 +/- 7570, and 11570 +/- 3830 (mean +/- sd) sites per cell. Dissociation constants in these subjects were 1.09 +/- 0.29, 0.93 +/- 0.22, 1.20 +/- 0.31, and 1.22 +/- 0.41 x 10(-10) mol/l respectively. There were no significant differences as to both maximal binding capacity and dissociation constant of androgen receptor among any groups. Abnormal receptor thermolability was not found in 5 patients with severe degree of hypospadias either. It is, therefore, concluded that prepubertal boys with isolated hypospadias have primarily normal androgen receptor activity.
Adolescent↗
[Perinatal management of congenital anomalies of the urinary tract detected in utero].
The routine use of maternal ultrasonography has led to frequent discovery of fetal anatomical abnormalities of the urinary tract. Herein we report on 35 cases with congenital urogenital anomalies which were found during the last 5 years by the prenatal ultrasonography and referred to our clinic either for treatment or consultation. 1. Findings of prenatal ultrasonography There were 12 cases of hydronephrosis, 7 of multicystic dysplastic kidney, 4 of megaureter, 3 of posterior urethral valve, 2 of ureterocele, 2 of vesicoureteral reflux and 5 other cases. Fetal anomalies were diagnosed during routine maternal examination, as intrauterine growth retardation, oligohydramnios, or the recurrent risk secondary to genetic risk factor or previous abnormal pregnancies. Prenatal diagnosis was made as early as 20 weeks of gestation in a case of hypoplastic urethra with large bladder diverticula. In about 30% of cases, abnormalities were found before 30 weeks of gestation. Oligohydramnios was evident in 5 cases. Prenatal diagnosis was correct in about 60% of cases. In the remainder the diagnosis was either incomplete or incorrect. Errors in the diagnosis resulted from difficulties in the differentiation of dilated ureter, intestinal dilation or intraperitoneal cystic masses. 2. Management in newborn periods Of the patients, 12 were treated urologically in newborn periods. Although patients with distended bladder and dilatation of upper tracts first underwent therapeutic placement of the urethral catheter, upper tract diversion with nephrostomy or tubeless ureterocutaneostomy was required in 2 because of continued elevation of serum creatinine levels. In 2 neonates nephrectomy was indicated for unilateral multicystic kidney, because the large cystic mass might compress the intestine.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Spontaneous resolution of reflux in children with primary VUR].
Although the adverse effects of vesicoureteral reflux on the renal function and renal growth have been well documented, there is still controversy regarding the factors for spontaneous cure of reflux and the time required for the resolution. We performed a retrospective analysis of 829 ureters in 541 children who have been followed for more than 3 years since 1973. Reflux was judged as spontaneously cured only after 2 micturition cystourethrograms (MCU) had shown no reflux. In total reflux resolved in 220 ureters (26.5%) of 182 children (33.6%). Resolution rate was 39.5% in boys and 28.0% in girls, and there was statistically significant difference between both sexes. In children who had underwent urethrotomy on congenital urethral stenosis, e.g. bulbous urethral stenosis in the boy and distal urethral stenosis in the girl, resolution rate was 43% in boys and 23% in girls. Resolution rate according to VUR-grade was 85.5% in grade I and II reflux, 45.8% in grade III, and 6.7% in grade IV and V. Of 92 children who underwent urodynamic evaluations, 37% showed findings of unstable bladder. Renal scarring was observed in 7.3% of renal units which was significantly less frequent than the incidence among total renal units with reflux. Reflux was resolved in 30% of renal units without scarring and 10% of renal units with scarring. The incidence of small kidney in the spontaneously resolved group was 3.6%, which was significantly lower compared to the total renal units with reflux. The mean age at resolution of reflux was 5.7 years in boys and 7.5 years in girls.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[A case of spontaneous disappearance of pulmonary metastasis of renal cell carcinoma following nephrectomy].
A 76-year-old man was admitted to our hospital on October 3, 1988 complaining of general fatigue and left flank pain. A large movable mass was palpable in his left flank. Intravenous pyelography and computerized tomography confirmed left renal tumor. Chest X-ray showed a coin lesion in the left lung. Left nephrectomy was performed on October 14, 1988. Histopathological diagnosis was adenocarcinoma of clear cell type. Chest X-rays, on the postoperative eleventh day, showed disappearance of the pulmonary coin lesion which was seen preoperatively. Recurrence of pulmonary metastasis has not been seen for 14 months after operation.
Aged↗