Biomedical subjects
Publications and source records attributed to T Nakada.
A case of simultaneous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is presented. This patient underwent right radical nephrectomy, partial resection of left ureter and bladder, and end-to-end transureteroureterostomy. He is alive with no finding of recurrence after 1 year. Methods of treatment for bilateral urinary tract tumors are reviewed.
We present a 68-year-old man with a huge bladder diverticulum associated with benign prostate hypertrophy treated with transurethral fulguration of the diverticular mucosa in combination with transurethral resection of the prostate. The procedure was well tolerated by the patient and unfavorable symptoms faded after this procedure. Follow-up cystogram demonstrated remarkable reduction of the diverticulum.
We injected 20 micrograms of prostaglandin E1 (PGE1) intracavernously in 32 patients with impotence, we then examined penile blood flow using a Xe-133 washout technique. In addition, we also performed a cavernosography. After PGE1 injection, 18 patients (56%) showed complete erection, 10 (31%) tumescence, and 4 (13%) no response. Fourteen patients who presented either an inadequate or no response to PGE1 injection were suspected to have vasculogenic impotence. Cavernosography of patients who showed good response after PGE1 injection demonstrated no obvious venous leakage. In this group penile blood flow decreased after full erection. However, 7 patients (50%) suspected to have vascular problems showed venous leakage. Subsequently, these 7 patients appeared to be cases of venous incompetence. The penile blood flow of these 7 patients before or after PGE1 injection was not statistically different from that of other groups. Based on these findings, cavernosography after PGE1 injection appears to be useful for differentiating the venous factor of impotence.
A 63-year-old man with primary malignant lymphoma of the prostate is presented. The patient underwent total cystoprostatectomy and ileal conduit construction. The specimen revealed malignant lymphoma, diffuse small cleaved cell of the gland. Three months after the operation, local recurrence and enlarged lymph node development were demonstrated by computed tomography. The patient tolerated well a combination chemotherapy of VP-16, doxorubicin, cyclophosphamide and prednisolone for 5 cycles. Tumor recurrence and lymph node spread could never be recognized following this drug treatment. The patient has been asymptomatic after this chemotherapy for over 3 years.
We report a case of Klinefelter's syndrome in a 3-year-old boy with unilateral cryptorchidism. The literature is reviewed, and hormonal condition and treatment of Klinefelter's syndrome are discussed.
We performed transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with transurethral prostatectomy or bladder neck resection to treat all aspects of diverticula in 9 patients. Eight cases with bladder outlet obstruction, involving 2 cases of large diverticula, have been successfully treated. A case with neurogenic bladder has failed. We found the transurethral procedure to be equally effective as open operation.
Left ventricular contractile function was compared between primary and two-stage arterial switch operation (ASO) in neonates and infants with simple transposition of the great arteries (TGA). Eight patients (group 1) underwent primary ASO at 13-42 (23 +/- 10 [mean +/- SD]) days of age, and five patients (group 2) underwent two-stage ASO after pulmonary artery banding and Blalock-Taussig shunting at 11-26 (15 +/- 3) months of age. Postoperative echocardiographic studies were undertaken at 6-48 (22 +/- 16) months of age in group 1 and 25-45 (32 +/- 7) months of age in group 2. The results were compared with those obtained from nine age-matched normal children (group N). To compare left ventricular contractile state among the patients, the deviations from the mean normal values in relations of end-systolic wall stress to fractional shortening and to rate-adjusted mean velocity of circumferential shortening (the stress-shortening index and stress-velocity index, respectively) were obtained for each patient. The stress-shortening index was significantly lower in group 2 (-3.1 +/- 3.1) than in group 1 (1.3 +/- 1.7, p less than 0.05); the stress-velocity index was significantly lower in group 2 (-3.3 +/- 1.8) than in group 1 (1.5 +/- 1.6, p less than 0.01) or in group N (-0.4 +/- 0.5, p less than 0.05). These results suggest that postoperative left ventricular contractility can be well preserved in patients after primary ASO for simple TGA in neonates, but there is a possibility of depressed contractility in patients after two-stage ASO.
We report a case of adrenal ganglioneuroma. A 29-year-old man was referred to our clinic for further investigation of right abdominal mass incidentally discovered by ultrasonography. Endocrinological study was unremarkable. Abdominal computed tomography revealed well-defined, 6-cm-long oval mass with mottled calcification. Adrenal scintigraphy showed enlarged adrenal gland with low accumulation. T1-image of magnetic resonance depicted hypointensity tumor in comparison with liver. Extirpation of this tumor disclosed yellowish white, homogeneous mass, 101 g in weight and 7 by 7 by 3.5 cm in diameter. Pathological diagnosis was ganglioneuroma. All reported cases of adrenal ganglioneuroma exceeded 5 cm in diameter. This indicates malignancy in computed tomography. Therefore, we should be careful in diagnosing ganglioneuroma.
We analyzed stage III and IV lung cancer with tumor size smaller than 3.0 cm. The percentage of adenocarcinoma among the patients with stage III A lung cancer was high. In survival rate, there was no observable difference between the patients with tumor size smaller than 3.0 cm and the patients with tumor size larger than 3.1 cm. But the ratio of the people who had a long survival was high in the latter group. Among the stage IV patients, the pm 1 group with N0 or N1 had a good prognosis (52%, 50% at 5 years).
A 61-year-old man was admitted to our hospital with cough, bloody sputum, and chest pain. Bronchoscopy showed a tumor in the truncus intermedius which biopsy and brushing cytology revealed to be squamous cell carcinoma. Also, bronchial washings grew only N. asteroides. Treatment with minocycline and trimethoprimsulfamethoxazole (TMP/SMX) over one month resulted in some improvement in pulmonary symptoms and resolution of the infiltrates in the right lower field. Then, right pneumonectomy was performed. N. asteroides was isolated from the resected tumor. Aggressive bacteriological examinations should be utilized when the possibility of pulmonary nocardiosis is considered.
Primary retroperitoneal tumors are reported to account for 0.2% of all malignancies. Furthermore, 10-20% of all primary retroperitoneal tumors are liposarcomas. Up to 1989, 213 cases of retroperitoneal liposarcoma have been reported in the Japanese literature to our knowledge. Mixed type liposarcomas were rare, and composed 13.8% of all retroperitoneal liposarcomas in this series. We described here a case of retroperitoneal mixed type liposarcoma. A 50-year-old man was admitted to our department with a mass in the left abdomen. Computed tomography and aortography revealed a huge and hypovascular tumor in the retroperitoneal cavity, not containing fat tissue. It was diagnosed as a retroperitoneal tumor and treated surgically. The tumor and the left kidney were encapsulated and could be removed en bloc. The size and weight of the tumor were 28 x 18 x 12 cm and 3,100 g, respectively. Histological examination of the mass proved it to be a mixed type liposarcoma. He was administered OK-432 as adjuvant therapy. After 11 months, bone metastasis to the vertebra appeared. Moreover, lung metastasis also occurred and he died of the disease 15 months after the operation.
The long QT syndrome (LQTS) is one of the important diseases that may lead to sudden death mainly in childhood, however etiology and pathogenesis are still poorly understood. The group studied consisted of 6 patients with a history of ventricular tachyarrhythmic syncope, 3 with long QT syndrome (LQTS) and 3 without long QT interval, and of 4 patients with ventricular tachycardia without syncopal episode. Their ages ranged from 5 years to 17 years. Histopathology of endomyocardial biopsy was nonspecific and mild in two cases but in one patient with LQTS, who had several episodes of syncope and refractory ventricular arrhythmia, remarkable subendocardial fibrosis, interstitial fibrosis and hypertrophy of myocytes were demonstrated. As far as ventricular tachycardia without long QT interval was concerned, in the patients with VT with syncope, histopathological abnormalities were more remarkable than in those without syncope. Electrophysiological findings in the patients with LQTS showed no characteristic findings, but only mild abnormalities with functional atrioventricular conduction disturbance on programmed atrial pacing. No inducible VT was demonstrated. Although electrophysiologic study and endomyocardial biopsy are of limited value, such studies are considered to be worthwhile for treating ventricular arrhythmias, and making a prognosis of the patients with tachyarrhythmic syncope and LQTS.
One hundred fifteen patients with small (less than or equal to 2 cm in diameter) peripheral lung cancer lesions underwent surgical treatment in the Department of Surgery, The Research Institute for Chest Diseases and Cancer, Tohoku University, Miyagi Prefecture, Japan. The authors investigated several prognostic factors of these cases. The 5-year survival rate of these 115 patients was 70%. Various factors such as histologic type, nodal involvement, pleural involvement, pathologic stage, and curativity of the operation were revealed to affect survival significantly. In patients with and without nodal involvement, there was no significant difference between the survival rate of patients with lung cancer lesions smaller than 2 cm and those with lesions 2.1 to 3 cm. However, the rate of lymph node metastasis was significantly different in the group with lesions smaller than 2 cm compared with those with lesions 2.1 to 3 cm (21% versus 43%, respectively).
Thin slice table incremental CE-CT was performed on 18 patients considered to have pancreatic carcinoma, 13 patients with chronic pancreatitis, and 19 patients with a normal pancreas. Each patient underwent precontrast CT scanning and delayed scanning. Computed tomography was performed with a high-speed scanner, a TCT 900s. First, precontrast CT scanning was initiated at the level of the top of the right diaphragm, and the scan sequence was performed to include the liver and pancreas at contiguous 10 mm intervals. Second, a bolus of 50-60 mL of 300 mgI/mL iopamidol was delivered intravenously by hand injection via a peripheral arm vein, and subsequent injections were administered during table incrementation with 2-second interscan delay, and the scan sequence was obtained at contiguous 5 mm intervals with a scan speed of 1-second. Delayed scanning was performed 1-2 minutes later after 12 images had been obtained by thin slice table incremental CE-CT scanning. The average CT numbers were calculated for each lesion by precontrast CT scanning, thin slice table incremental CE-CT scanning, and delayed scanning. For the patients with pancreatic carcinoma, the average CT numbers were 41.6HU +/- 6.4HU, 69.6HU +/- 10.4HU, and 86.2HU +/- 14.7HU by precontrast CT scanning, thin slice table incremental CE-CT scanning, and delayed scanning, respectively. While for the patients with chronic pancreatitis, the average CT numbers were 50.0HU +/- 5.0HU, 94.3HU +/- 13.3HU, and 82.5HU +/- 11.6HU, respectively, and for those with a normal pancreas, the average CT numbers were 51.3HU +/- 5.7HU, 93.5HU +/- 7.6HU, and 82.0HU +/- 11.6HU, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Experimental and clinical studies were done on intracavitary and interstitial hyperthermia with a 2 mm diameter applicator with a 7 cm tip (Aloka, Co., Ltd.). Microwave energy at 2450 MHz was used to heat tumors. An outer cannula of 16G Medicut was implanted in the tumor. When a rabbit VX-2 tumor was heated, the temperature reached over 40 degrees C at 15 watts. We applied the same method to two patients, one with recurrent oropharyngeal tumor and the other with recurrent pelvic tumor. This applicator looks promising.
The follow-up study has been performed in 4 male patients with nephrogenic diabetes insipidus lasting for 4 to 15 years. Hydronephrosis or hydroureter appeared to be caused by polyuria with or without urinary tract obstruction. The efficacy of drainage operation is emphasized when polyuria surpasses the transporting ability of urine in the urinary tract.
Before and after androgen replacement therapy prostatic and seminovesicular volume was estimated by means of transrectal ultrasonography in 13 hypogonadal men. Volume of the prostate (p less than 0.001) and seminal vesicles (p less than 0.01) significantly increased after treatment with testosterone enanthate. However, the plasma level of testosterone remained abnormally low. These results indicate that volume determination of the prostate and seminal vesicles by means of transrectal ultrasonography is suitable for evaluating the adequacy of androgen replacement therapy in male hypogonadism.
Low level of plasma atrial natriuretic factor (ANF) under altered dietary sodium and its elevation during bigeminy were found in a 40-year-old woman with idiopathic oedema. The natriuretic effect of this peptide and the role of renin-angiotensin-aldosterone system in oedema formation in this disorder are discussed.