[Male sexual dysfunction].
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Biomedical subjects
Publications and source records attributed to K Fukutani.
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Results of DNA study on two patients of gonadal dysgenesis with a 45,X/46,X,Ynf (non-fluorescent Y chromosome) karyotype are described. In one patient who developed gonadoblastoma, all 12 loci on the non-fluorescent part of Yq were detected. Another patient did not have gonadoblastoma at 20 years, and only the proximal 6 loci out of 12 were detected.
An XX true hermaphrodite was examined for the presence of Y-specific sequences using Southern-blotting and polymerase chain reaction (PCR) techniques. Of 25 loci examined, only two, the proximal border of the pseudoautosomal region (PABY) and the sex determining region of the Y chromosome (SRY), were detected. A crossing over event in paternal meiosis, proximal to the SRY locus but distal to the zinc finger protein (ZFY) locus, presumably transferred to two loci to the X chromosome.
We have developed a novel positive cloning vector whose use precludes the cloning of any fragments less than 0.8 kb as well as 3.4-kb EcoRI fragments of DYZ1, the largest repeating-DNA family on the long arm of the human Y chromosome. Using this vector, we subcloned inserts of a Y-chromosome-specific phage library constructed from EcoRI-digested flow-sorted Y-chromosome DNA. Ten novel Y-specific fragments were obtained. Their localization on the Y chromosome was determined by deletion mapping using clinical samples with structurally abnormal Y chromosomes. The long arm of the Y chromosome was divided into 12 segments by the novel probes in combination with established probes. The amelogenin-like sequence, mapped on the long arm in Human Gene Mapping 10, has been mapped on the short arm.
The effects of long-term administration of theophylline on the pituitary-thyroid axis were investigated. In the first study, the changes in serum thyroid hormone, TSH and cortisol levels were examined before and after 2 week-administration of sustained-release theophylline in 5 normal and 10 asthmatic subjects. In the normal subjects, the hormone levels did not change before or after theophylline administration. On the other hand, in the asthmatics, serum TSH levels increased (p less than 0.05) and serum free T3 levels decreased (p less than 0.05) after 2 weeks. In the asthmatics, basal T4 levels had a significant correlation with both basal T3 and rT3 levels, but T4 levels after 2 weeks correlated significantly with rT3 alone. In the second investigation, the effects of long-term administration were studied in 15 asthmatics not on theophylline (group 1), 20 asthmatics on theophylline (group 2), and 20 asthmatics on theophylline and glucocorticoids (group 3). TSH levels in group 2 were significantly higher than those in groups 1 and 3. Although in group 1 there was a significant correlation between T4 levels and T3 and rT3 levels, in group 2 T4 levels correlated significantly with rT3 levels alone. In conclusion, these results suggest that although long-term theophylline treatment may increase the secretion of TSH from the pituitary in asthmatics, in the peripheral tissue it may decrease the conversion of T4 to T3, resulting in the diminution of active hormones.
We measured serum inhibin levels in eight untreated patients with prostatic cancer undergoing castration by RIA using an antiserum against 31-kDa bovine follicular fluid inhibin. The inhibin concentrations in testicular tissue and spermatic venous blood were also measured in six of these patients. Serum inhibin levels (mean +/- SD, 377.8 +/- 212.1 U/L), declined rapidly after castration (15 min after, 233 +/- 171.4; 30 min, 224.6 +/- 156.6; 1 h, 181.5 +/- 95.9; 2 h, 174.3 +/- 69.4; 4 h, 122 +/- 6.4; 6 h, less than 120). High concentrations of inhibin were detected in testicular tissue (31,360 +/- 15,180 U/kg), and the levels in spermatic venous blood (3,178.3 +/- 1,386.8 U/L) were approximately 10 times greater than those in peripheral blood (385.5 +/- 233.1 U/L). Testosterone levels were 1,968.2 +/- 992.3 nmol/kg in testicular tissue and approximately 100 times greater in spermatic venous blood (1,631.6 +/- 389.7 nmol/L) than in peripheral blood (18.0 +/- 4.4 nmol/L). These results suggest that circulating inhibin in men mainly originates from testis and that one of the routes of secretion is via the bloodstream.
Last year, we reported that human papilloma virus type 16 genome (HPV 16 genome) was detected in a case (S.Y.) of bladder carcinoma in situ (bladder CIS) (Cancer Res., 1988). Since then, a number of bladder tumors other than CIS were searched for HPV genome. However, no HPV genome was detected in the bladder tumors. From the results, we consider that HPV may not have a relation with all types of bladder tumor but with only a part of it. In the current report, the case (S.Y.) is presented more precisely than before, in particular on the characteristic bladder lesion. The patient was a 40-year-old female with immunodeficiency and anemia who was referred from a hospital with a complaint of asymptomatic pyuria. Cystoscopic examination revealed a bladder tumor, well-demarcated, white and velvety lesion with slight elevation. On November 25, 1987, she underwent total cystectomy, resection of the anterior vaginal wall and of a part of vulval skin, and ileal conduit formation. Postoperative course was stormy because of bleeding from the wounds and thrombophlebitis in the right femoral vein. In spite of the episodes, she eventually recovered and was discharged 2 months later. However she was readmitted 9 months later due to severe anemia which was ascribed to acute myelogenous leukemia. She is now on cancer chemotherapy for leukemia.
Three children at the ages of 4, 10 and 12 years, with external genital malformation, were diagnosed to be with the Klinefelter syndrome by chromosome analysis. To clarify the pubertal changes in this syndrome, all of them were studied for physical and endocrinological examinations and two underwent testicular biopsy. Before puberty any remarkable abnormality were not observed in the hypothalamus-pituitary-gonadal axis and in the physical status. After the onset of puberty they started showing increases of the basal levels of plasma FSH and LH with over-response to LH-RH stimulation test. During the period of this study the levels of plasma testosterone were in the normal range and increased gradually with age. One boy showed a transient high level of plasma testosterone at early puberty. The reactions of plasma testosterone to HCG stimulation of all cases showed the normal pattern. The histological examination of the testis revealed that the number of spermatogonia was reduced in both cases compared with that of normal boys reported by Mancini et al. These findings indicate that most endocrinological and histological abnormalities in adult Klinefelter syndrome occur after the onset of puberty. These changes may be induced at puberty by hypergonadotrophic condition which result from slightly impaired testicular function which is present before puberty.
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Seventy-four new cases of prostatic carcinoma treated between 1981 and 1985 were analyzed. The patients were between 40 and 86 years old with a mean age of 72.2 +/- 7.7 years. More than 70% of the patients had clinical stage C and D carcinoma. All cases proved histologically to be adenocarcinoma of the prostate. Eighteen patients had well differentiated, 21 moderately differentiated and 35 poorly differentiated adenocarcinoma. Various hormonal treatments were performed as the initial treatment in 88.9% (64/72) of the cases. Among them, 37 cases were treated by estrogen and 22 cases by luteinizing hormone releasing hormone analogues. Fourteen of 64 patients (21.9%) who received hormonal treatment discontinued the therapy within 10.1 +/- 9.1 months because of relapse of the disease or no therapeutic response. Salvage therapy following hormonal treatment were chemotherapy (9/14) and radiation therapy (4/14). During the 5-year follow up 12.1% (9/74) of the patients died due to prostatic carcinoma.
Two cases of the urothelial cancers associated with extramammary Paget's disease are reported. In one patient, vulvar Paget's disease was discovered 6 years after complete resection of a ureteral tumor. In another patient, vulvar and vaginal Paget's disease developed during a period of repeated transurethral surgery leading up to the final total cystectomy for recurrent bladder carcinoma. Since genital Paget's disease is frequently accompanied by internal malignancies, a skin biopsy is mandatory when an eczematous lesion has been persistent in the genital region of patients with genitourinary cancers.
A 75-year-old woman with transitional cell carcinoma of the renal pelvis was revealed to have sarcoid granulomas within the kidney as well as in the renal pedicle lymph nodes. Furthermore, noncaseating granulomas had been found in the pelvic lymph nodes in a histological study following previous total cystectomy for bladder cancer. The association of sarcoidosis with genitourinary malignancies is briefly discussed.
Twenty-three patients who underwent conventional total cystectomy were examined regarding postoperative potency. Two patients who were subjected to simple cystectomy and whose partial prostate and whole seminal vesicles were left showed full erection and normal ejaculation 1-2 months after surgery, thus giving 100% potency after simple cystectomy. In contrast, of 12 patients who underwent radical cystectomy alone, only 3 (25%) regained potency postoperatively, and the strength and duration of erection were not satisfactory for 1 of the 3 patients. Nine patients who received radical cystectomy and urethrectomy did not show signs of potency postoperatively. The sum total postoperative potency rate in the 21 patients subjected to radical cystectomy was 14.3% (3/21). The facts may indicate that urethrectomy is harmful for postoperative potency because damage of the cavernous nerves probably takes place during surgery. To avoid nerve damage, the urethra should be left intact during radical cystectomy employing the nerve-sparing technique developed by Walsh and Donker unless the posterior urethra is invaded by bladder carcinoma. In addition, it was demonstrated that pelvic irradiation might cause impotency as neither pelvic lymph node dissection nor cisplatin administration had any influence on postoperative potency.