Biomedical subjects
Publications and source records attributed to H Fuse.
A 55-year-old man with Behçet's disease presented acute urinary retention due to Cryptococcus neoformans infection of the prostate. The disease was localized to the prostate. The infection was successfully treated only with fluconazole. The patient remains well without evidence of systemic or local infection at 32 months.
Bilateral vasovasostomies were performed in 7 previously vasectomized patients. The method employed was a modification of a one-layer anastomotic technique. There was no correlation between the presence of absence of sperm in the vas fluid, presence or absence of sperm granuloma, and site of vasectomy. No correlation was revealed between the presence or absence of sperm in the vas fluid and the duration of obstructive period. After vasovasostomy, sperm was observed in the ejaculate in 86% of the patients. Only one patient's partner became pregnant. However, the partner of one patient with short postoperative period and good seminal finding after vasovasostomy was expected to become pregnant. This modified method of one-layer microsurgical vasovasostomy can be performed more easily and quickly, but requires further clinical experience and evaluation of usefulness.
We investigated bone marrow scintigraphy in 20 patients with prostate cancer to determine the usefulness of this procedure in the diagnosis of bone metastasis. Thirteen of 17 patients whose bone scans revealed hot spots showed accumulation defects in bone marrow scintigrams. Follow-up study and X-ray, computed tomography and/or magnetic resonance imaging findings confirmed the presence of bone metastases in these patients. On the other hand, 4 patients with abnormal bone scans had normal bone marrow scintigrams, and were subsequently demonstrated to have degenerative changes of the spine. Bone marrow scanning therefore appears to be useful in distinguishing metastatic lesions from degenerative changes in cases with suspected bone lesions.
Fifteen patients with hydroceles of the testis or spermatic cord were treated by aspiration and injection of the sclerosant solution polidocanol. The cure rate of hydroceles after one sclerotherapy session was 73%, and the overall cure rate using the procedure was 87%. No patient experienced pain during or after the procedure, which was conducted without anaesthesia. No complications were observed. It is concluded that sclerotherapy of hydroceles with polidocanol may be a useful alternative to open operation, due to its ease of administration, low frequency of complications, and high rate of effectiveness, and that this agent is preferable to certain other drugs in that it causes no pain during or after the injection.
Crystal adherence to the surfaces of indwelling urinary catheter materials was investigated by scanning electron microscopy and immunofluorescence method. Small sterile disks were inserted into the rat bladder transvesically. Crystals were frequently associated with fibrillar material, some of which was believed to be fibrin. Increases in fibrillar materials were paralleled by increases in crystal adherence. On the other hand, a decrease in the amount of fibrin adhering to the surfaces of heparinized material, resulting in a decrease in the quantity of encrusting deposits on these materials, was found as compared with other catheter materials, including latex, silicone and nonheparinized material. These findings suggest that early adherence of fibrin to the surfaces of indwelling urinary catheter materials plays an important role in the development of crystal adherence and encrustation on catheter materials. It is also suggested that heparin inhibits the adherence of fibrin, resulting in decreased encrustation on the surfaces of the heparinized material.
Epidermal growth factor (EGF) content in seminal plasma of 17 patients with androgen deficiency (12 Klinefelter's syndrome and 5 hypogonadotropic hypogonadism) was determined before and after hormone replacement. No significant increase of plasma testosterone level was demonstrated after testosterone administration in Klinefelter's syndrome, although the level in 4 of 5 patients with hypogonadotropic hypogonadism reached the normal range. In 16 patients, except 1 with hypogonadotropic hypogonadism with no increase of blood testosterone level, prostate volume increased after hormone therapy, and volumes after treatment were significantly larger than those before treatment. On the other hand, EGF concentration in seminal plasma remained at the pretreatment level in most patients. It is therefore concluded that although the prostate volume increases to almost normal after treatment, prostate function does not improve in most patients, indicating that in patients with hypogonadotropic hypogonadism fertility potential may remain low, even if they obtain normal seminal parameters after treatment.
The diagnostic significance of transrectal prostatic ultrasonography for chronic prostatitis and varicocele was evaluated in 380 male infertility patients. Of 20 patients with pyospermia, thought to be mainly caused by chronic prostatitis, 10.0 percent showed heterogeneous echo pattern of the prostate, while 25.0 percent showed capsular irregularity. Since 285 patients with non-infected semen showed similar sonographic findings, it is concluded that prostatic ultrasonography has little value in the diagnosis of chronic prostatitis in infertile patients. Enlarged periprostatic echo-free zone, thought to coincide with the dilatation of the Santrini's plexus, was found in 42.9 and 42.7 percent of patients with chronic prostatitis and varicocele, respectively, in contrast to 34.0 percent of patients without either diseases. Twelve percent of patients with varicocele showed highly enlarged echo-free zone, which was significantly more frequent compared to 5.0 percent in normal patients. Moreover, follow up of 4 patients with varicocele pre- and post-operatively found 2 of them to show a great improvement in the enlargement of the zone. These results suggest that varicocele may cause the dilation of the Santrini's plexus through a venous anastomosis in some patients and transrectal ultrasonography may be a useful tool in detecting small varicoceles in such patients.
We reviewed our experience of using double Malecot polyurethane intraurethral catheters (IUC). Ten patients with dysuria were treated between April 1991 and April 1993. Seven patients with benign prostatic hypertrophy (BPH) were judged as in a high risk group for operation. The three other patients had neurogenic bladder (two had underactive bladder and 1 had overactive bladder). Under local anesthesia, 150 ml of 0.1% Povidone iodine solution was infused into the bladder through a Nelaton catheter. Under guidance by ultrasonography, an IUC was placed into the bladder neck and posterior urethra using the specially designed introduction set. An long-term follow up of the BPH patients, two IUCs were removed for operation and one was exchanged for an indwelling catheter because of deterioration in general condition. In the neurogenic bladder patients, all IUC were removed because of the increase of residual urine, formation of a pseudourethra, or dislocation into the bladder. Side effects were observed in 6 patients such as, urethral bleeding and stone formation in the stent. Erosion and bleeding tendency in the urethral mucosa were shown in the prolonged duration cases. We conclude that a urethral stent is an effective devise for a high risk patient with benign prostatic hypertrophy but we must keep each patient under strict observation for complications during IUC placement.
Thirty five patients with renal pelvic and ureteral tumors were treated at our hospital between 1979 and December 1992. Thirty patients were male and five were female. They ranged in age from 44 to 80 years old (average 67.4 years). The most frequent symptoms were hematuria that was found in 31 cases (24 gross hematuria and 7 microscopic hematuria). Histopathologically, there were 30 transitional cell carcinomas (TCC), 1 squamous cell carcinoma (SCC), 2 TCC > SCC and 1 papillary adenocarcinoma. As to staging, 1 was pTis, 5pTa, 11pT1, 3pT2, 11pT3 and 4pT4. As to grading, 9 were G1, 16 G2 and 9 G3. The incidence of cancerous vessel invasion was noted in 8 of the 29 patients. The 5-year survival rate (Kaplan-Meier's method) was 44.9% for all of the patients. The 5-year survival rate according to staging and according to grading were as follows: 76.7% for low stage (pTis, pTa, pT1, pT2), 24.9% for high stage (pT3, pT4), and 83.3% for G1, 59.9% for G2 and 0% for G3. The 5-year survival rate was 20.8% and 68.7% in the patients with and without vessel invasion, respectively. Grade, stage and cancerous vessel invasion was suggested to be associated with the prognosis in renal pelvic and ureteral tumors.
Eight patients with benign prostatic hypertrophy (BPH), considered as a high risk for an operation because of severe accompanying disease, were treated with a self-retaining intraurethral catheter set. Two patients were judged unfit for operation (one because of severe cardiac failure, the other because of severe respiratory failure) and 1 patient rejected an operation. The BPH surgery was postponed in the others because of recent operations for such diseases as gastric cancer or because of severe gastric ulcer. All patients voided freely after stent placement and were continent. The device was left in place for 1 to 16 weeks. The chief complaint was frequency of voiding, with intervals of 1 to 2 hours. Some micturition discomforts such as urgency were recognized in 2 patients, but disappeared within 1 to 2 days. Pyuria observed before treatment disappeared in all but 1 patient. Average residual urine volume calculated on ultrasonograms was 54 ml. Stone formation was demonstrated in 1 patient 9 weeks after placement. We concluded that the intraurethral stent is an effective device for high-risk patients with BPH. However, a longer follow-up study will be needed to exclude late side effects.
A 62-year-old female patient underwent an operation for a brain tumor. The pathological diagnosis of the resected specimen was metastatic adenocarcinoma with signet-ring cells. The primary lesion was found in the ascending colon. In addition, a non-papillary and pedunculated tumor was found on the right wall of the bladder on cystoscopy. Biopsy of the bladder tumor showed adenocarcinoma with signet-ring cells, which was the same as the histologies of the colon and the brain tumors. Under the diagnosis of metastatic bladder tumor, transurethral resection of the tumor was performed. This is the first case of metastatic bladder carcinoma from the colon reported in Japan.
Protection of the spermatogenic cells against anticancer drugs can be performed by temporarily interrupting testicular blood flow during drug administration. In our study we investigated the effect of ischaemia on spermatogenesis, using mature male Sprague-Dawley rats. Eight and 16 weeks after a 1 h period of left testicular ischaemia, left testicular weights significantly decreased compared with the controls (both, p < 0.05). The decreased testicular weights returned to almost normal values at 24 weeks. Sperm counts in the left cauda epididymis were significantly reduced 8, 16 and 24 weeks after ischaemia (p < 0.01, p < 0.01 and p < 0.05, respectively). Sperm motility also decreased 8 and 16 weeks after the procedure (both, p < 0.01). These parameters returned to normal at 48 weeks. The diameter of seminiferous tubules in the left testis was diminished 8 and 16 weeks after testicular ischaemia, and increased tubular wall thickness on the left side was demonstrated 8 weeks after ischaemia (each, p < 0.05). No changes in the parameters at any interval after ischaemia were observed in the right testis. The serum levels of LH, FSH and testosterone showed no alteration throughout the experiment. The present study reveals that testicular damage induced by ischaemia up to 1 h is completely reversible and no contralateral orchiopathy is produced by this procedure.
We experienced 20 cases of methicillin-resistant Staphylococcus aureus (MRSA) infection from April 1991 to September 1992. Of them, 9 showed substantial morbidity and their clinical courses are herein reported. The clinical presentations of these cases were wound infection and enterocolitis. Although in 8 cases MRSA was eradicated in 14 to 160 days by effective antibiotics administration, one had a fatal outcome. All strains isolated showed similar drug-sensitivity pattern suggesting hospital infection. Sensitivity to vancomycin and arbekacin, however, remained high and these drugs were effective clinically. It should be stressed that treatment strategy of MRSA infection should consist of isolation of patients with MRSA from other patients, use of disposable equipment and products, and serious and continuing concerns of medical personal on communicability of MRSA.
An 81-year-old male patient visited our hospital on November 13, 1992 for the treatment of penile edema that had been caused by a metallic ring which he placed for fun 4 days prior to the visit. He had placed the metallic ring on the base of the penis and subsequent penile edema made it impossible to remove the ring. He had no problem with urination. The ring was successfully removed with a metal-cutting tool. But 3 days later, infected penile ulceration occurred at the base of the penis and the necrotic tissue was resected. It took 25 days for the wound to heal. It is stressed that penile strangulation is a serious injury and prompt removal is necessary.
A phase I study of orally administered flutamide (a pure anti-androgen) was performed in 26 patients with prostatic cancer. No side effects were observed in 11 patients receiving single doses of either 125, 250, 375 or 500 mg. However, in the daily dosing schedule of 375, 750, 1125 and 1,500 mg/day doses, where medication was taken in three divided doses, discomfort in the stomach, nausea, vomiting and anorexia were experienced in one of the four patients receiving the highest dose of 1,500 mg. Nine patients receiving the other doses did not complain of toxic symptoms. Laboratory values did not change in the three patients receiving the lowest 375 mg/day dose, but elevation of transaminase was observed in five of the nine patients given higher doses. This elevation was observed in all the three patients receiving 1,500 mg/day dose. Among the serum hormone levels, significant increases of luteinizing hormone were observed. As for efficacy, objective responses were observed in two of the three patients in each of the four daily dosing groups. Improvement of pain, voiding obstruction symptoms, and performance status were also observed. Flutamide was found to be absorbed rapidly and to exist as a hydroxylated form (hydroxy-flutamide) in the plasma. The half-life of hydroxy-flutamide was similar in the single and daily administration, but the peak concentration and area under the concentration versus time curve in the daily administration became greater than those in the single administration. In conclusion, flutamide should be examined for efficacy and safety using doses of 375 to 1,125 mg/day in the phase II study.
Fourteen 46,XX "males" were analyzed by Southern blot hybridization with seventeen different Y chromosome-derived DNA probes and by the polymerase chain reaction for an additional two sites on the short arm of Y. Eight 46,XX males possessed various segments of the short arm of the Y chromosome, including the sex determining region. The detected segments ranged from the two most distal loci to nearly the entire length of the short arm, viz., 10 out of 11 loci. None of the eight patients had hypospadia. Five out of the six remaining cases had hypospadia and no Y sequence was detected, suggesting the presence of a causative difference between hypospadiac and non-hypospadiac groups.
From 1979 to January 1990, 48 patients with newly diagnosed superficial bladder tumours were treated by transurethral resection (TUR) at Toyama Medical and Pharmaceutical University Hospital. The relationship between tumour recurrence and the stage, grade, number, or size of the tumours was investigated. The 1-, 2-, 3-, 4- and 5-year non-recurrence rates were 72%, 63%, 47%, 40%, and 40%, respectively. Non-recurrence rate for pTa tumours was significantly higher than that for pT1 tumours (p < 0.05). There was no relationship between tumour grade and recurrence. The rate of recurrence of multiple tumours was higher than that of single ones. There was no difference in non-recurrence rate between tumours smaller than 1 cm and those of 1 cm or larger. Non-recurrence rate in the instillation therapy group was significantly higher than in the non-instillation group (p < 0.05). It was concluded that patients with multiple or high-stage tumours have the risk of a high rate of recurrence and that intravesical chemotherapy is effective in preventing local recurrence in some patients.