Biomedical subjects
Publications and source records attributed to Y Tada.
We report two cases of unilateral renal angiomyolipoma. In both cases, our preoperative diagnosis was renal cell carcinoma because no low density area compatible with a fatty tissue was noted in the tumors. Histological examination revealed both tumors to be angiomyolipoma mainly composed of myomatous cells and immature fat cells.
A case of bilateral renal cell carcinoma is reported. The patient was a 82-year-old male with a chief complaint of hematuria. Echogram, pyelogram and computed tomogram of abdomen revealed a left renal tumor, in addition right renal tumor also was found. Then, he underwent a radical right nephrectomy and a left partial nephrectomy. After the operation renal function was transiently impaired, but recovered two months later. The patient was followed up without any adjuvant therapy. Lung metastases were found at 1 year after the operation, and he died in spite of administration of alpha-interferon. In the present case, the bilateral renal tumors are presumed to have been caused by metastasis from contralateral tumor, since lung metastases were found.
A 42-year-old woman who had a coronary artery fistula, associated with a giant coronary saccular aneurysm was reported. The coronary artery fistula originated from the proximal portion of the right coronary artery drained into the superior vena cava. The chief complaint was heart murmur which was detected at the 2nd intercostal space of the right sternal border. No other symptoms were present. The aneurysm was approximately 5 X 7 cm in size. In the operation using cardiopulmonary bypass, the proximal and distal portions of the coronary artery fistula were ligated successfully without aneurysmorrhaphy. The postoperative conditions was even without any complications. Congenital coronary artery fistulas with a giant saccular aneurysm should be surgically treated as soon as possible because of potential risk of aneurysmal rupture.
Three patients underwent surgery for postmyocardial infarction ventricular septal perforation (VSP) within 3 to 21 days after onset of infarction. The hemodynamic stabilization was not obtained despite aggressive medical treatment including Intra-aortic Balloon Pumping (IABP) in one patient. The others had sudden hemodynamic deterioration during IABP support. In two of the three cases, the VSP were closed via transinfarct ventriculotomy with double Dacron patch, and ventricular wall reconstruction was performed to sandwich the double septal patch between ventricular free walls with Dacron felt strips. Two of the three patients survived. Our experience suggests that early surgical intervention is essential unless medical therapy results in clinical improvement and the double patch method may provide a successful operative repair and comeout.
A 70-year-old man was admitted to our hospital with the complaint of lower abdominal mass. Previously, he had received partial cystectomy and radiation of 38 Gy for bladder transitional cell carcinoma and transurethral resection of prostate and diethylstilbestrol administration for prostatic adenocarcinoma. The third tumor was located between the bladder and lower abdominal wall with inguinal lymph node swelling. Biopsy specimen revealed malignant lymphoma. After 2 courses of combination chemotherapy consisting of vincristine, prednisolone and procarbazine, complete remission was achieved. We discuss about multiple malignancies including urological organs.
A series of three adrenal tumors is reported. They were discovered incidentally on ultrasonography for screening. One case was a benign pheochromocytoma and the others were non-functioning adrenocortical adenomas. They were hypoechoic on ultrasonography and were 4.5 x 3.5 x 4.0, 3.0 x 2.5 x 2.5 and 3.5 x 2.5 x 2.0 cm. Non-functioning adrenal tumors of a diameter smaller than 3.0 cm generally tended not to require surgery. Ultrasonography is useful for screening and evaluating patients with an adrenal mass without surgery as well as is computed tomographic scan.
We reported a case of syphilitic aortic arch aneurysm, which was examined by IADSA, X-ray CT and MR Imaging. A large aneurysm with the thick mural thrombus and central narrow lumen was clearly shown by MR Imaging. MR Imaging is an useful modality for the diagnosis of the aortic arch aneurysm with a very narrow lumen, which cannot be easily pointed out by IADSA.
We report two cases of epidermoid cyst of the testis. Case 1: A 57-year-old man was admitted to Osaka University Hospital with the chief complaint of a small nodule in the left scrotal content. Physical examination revealed that a little-finger tip sized hard mass was palpable at the upper part of the left testis. Left orchiectomy was performed under the diagnosis of testicular tumor. Histological diagnosis was epidermoid cyst of the testis. Case 2: A 25-year-old man was admitted to Osaka Kosei-Nenkin Hospital with the chief complaint of a nodule in the left scrotal content. Ultrasonographic examination revealed a hypoechoic lesion with echogenic rim in the left testis. Left orchiectomy was performed under the diagnosis of testicular tumor. Histological diagnosis was epidermoid cyst of the testis. In both cases, no evidence of recurrence has been noticed.
To document the severity and degree of renal injury multiple studies may be necessary, including excretory urography, nephrotomography, arteriography and ultrasonographic examination. Even these extensive studies fail at times to provide sufficient information for treatment of the injury. However, the parenchymal injuries and extrarenal hematomas are depicted more accurately by computed tomography (CT). Moreover, dynamic CT can assess parenchymal enhancement during the capillary phase. Therefore, dynamic CT is useful in assessing the renal contusion and hematoma. In addition, it appears to be highly reliable and relatively noninvasive means of diagnosing renal trauma.
Patients with hypophosphatasia caused by a deficiency of alkaline phosphatase first showed marked accumulation of phosphoethanolamine and other phosphorus compounds in kidney and liver, while in placenta and intestine contents of these compounds were within a normal range. Furthermore, 32P-incorporation in cultured skin fibroblasts of patients with hypophosphatasia was increased about two to three times of control. FPLC chromatographic analysis also indicates that the accumulated phosphorus compounds in hypophosphatasia was smaller molecular phosphorus containing compounds. These data provide new pathophysiological aspect of hypophosphatasia.
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The statistics of urological operations performed at our department between Jan., 1, 1982 and Dec., 31, 1986 were reviewed. During the 5 year period, 2331 patients were admitted to our hospital and 2192 urological operations were performed on 1834 patients. These statistics were compared with earlier statistics for two periods (1972-1976 and 1977-1981) and the recent trend of urological operations was investigated. With regard to operated organ, operations on the kidney were the most frequent followed by those on the urinary bladder. Operations on the ureter decreased during the recent 5 year period and they were the fourth most frequent following those on the scrotum, scrotal contents and penis. Operations on the adrenal gland, retroperitoneal space and parathyroid gland have gradually increased. As in the former report, transurethral resection of bladder tumor (TUR-Bt) was the most frequent and nephrectomy, TUR of prostate (TUR-P) and renal allotransplantation have followed. TUR-Bt and TUR-P have increased more and more and due to the introduction of percutaneous nephrolithotripsy and transureteral lithotripsy, open surgery for urolithiasis has greatly decreased. Endourological operations will still be on the increase.
A twenty-nine-year old female was diagnosed as the associated aortic arch aneurysm 14 years after the initial diagnosis of the pseudocoarctation of the aorta. The aneurysm was asymptomatic and aortogram revealed that it was located just proximal to the pseudocoarctation. The aneurysmal wall was so thin that intraluminal blood stream could be visible easily during operation. Aneurysmectomy and Dacron graft implantation was successfully performed with temporary bypass procedure. In most of the cases, pseudocoarctation of the aorta has been reported to be a congenital entity without indication for any surgical intervention. However some cases in the literature were combined with formation of the aneurysm during the long term follow-up period. Careful observation must be needed for a case of pseudocoarctation of the aorta and the associated aneurysm should be treated surgically even if asymptomatic.
Human erythrocytes contain glucosylated and nonglucosylated Cu-Zn-superoxide dismutases which can be separated by boronate affinity chromatography. The percentage of the glucosylated form is significantly increased in the erythrocytes of patients with diabetes as compared to normal erythrocytes. The nonglucosylated form of Cu-Zn-superoxide dismutase, which was washed through the boronate column, was glucosylated in vitro upon exposure to radioactive or non-radioactive D-glucose. Incorporation of D-glucose into the protein was observed, and with the increase in glucosylation, the enzymatic activity decreased, indicating that the glucosylation of the enzyme led to a low active form. This is the first demonstration that superoxide dismutase is glucosylated in erythrocytes and that the glucosylation leads to the inactivation of the enzyme.
Peripheral blood lymphocytes derived from patients with renal cell carcinoma were stimulated with interleukin 2 and tested in a 4-hour 51chromium-release cytotoxicity assay against autologous cultured tumor and myeloid K562 cells. Of 23 patients autologous tumor lysis of more than 0 per cent was observed in 20 (range 5.3 to 82.8 per cent) and more than 10 per cent lysis was noted in 16. Since no significant correlation between the degree of cytotoxicity and the pathological findings of tumor stage, grade, cell type or lymphocyte infiltration in the tumor was found, it was impossible to predict from the pathological findings which tumor could be lysed by peripheral blood lymphocytes treated with interleukin 2. Comparison of natural killer cell activity against K562 of freshly prepared peripheral blood lymphocytes to that of interleukin 2-treated lymphocytes revealed significant augmentation from 23.6 +/- 9.7 to 65.2 +/- 29.1 per cent. From the kinetics study the lysis of autologous tumor cells was detectable on day 2 of interleukin 2 exposure and the peak activity was observed on day 5. A similar trend was noted in regard to K562 cell lysis. Measurements of peripheral blood lymphocyte subsets with monoclonal antibodies and argon ion laser flow cytometry resulted in a significant decrease of cells positive for OKT 4 (helper/inducer) and a significant increase of cells positive for OKT 8 (suppressor/cytotoxic) and Leu 7 (natural killer) by interleukin 2 treatment. A cold target cell inhibition test was performed in 2 patients with unlabeled autologous tumor and K562 cells as cold inhibitors. In 1 patient unlabeled K562 completely inhibited the tumor lysis but in 1 complete inhibition by autologous tumor and incomplete blockade by K562 were found. From this observation we concluded that peripheral blood lymphocytes treated with interleukin 2 lysed not only autologous tumor cells but also K562. Our results demonstrate that adoptive immunotherapy with peripheral blood lymphocytes activated by interleukin 2 in patients with renal cell carcinoma could be appropriate as a therapeutic procedure.
Serratia marcescens was easily induced to form spheroplasts by beta-lactam antibiotics in the presence of Ca2+ or Mg2+ without an osmotic stabilizer such as sucrose. The spheroplasts grew in volume, although they could not divide. They were stable for more than 10 h at 37 degrees C in a medium containing a high concentration of antibiotic, and they had the ability to revert to the original bacillary form. Ca2+ was more effective in spheroplast induction than Mg2+. The effect was proportional to the concentration of cations. In 40% of 180 clinical isolates of S. marcescens, more than 40% of the original bacterial cells were induced to form spheroplasts by ceftizoxime in a medium supplemented with 40 mM Ca2+. A high spheroplast induction rate was observed even in medium with 10 mM Ca2+. Few isolates that were supersusceptible to ceftizoxime (MIC, less than 0.2 microgram/ml) were induced to form spheroplasts at a high rate. No difference in spheroplast induction rate or extent between antibiotic-resistant strains and relatively susceptible strains (MIC, greater than 0.2 microgram/ml) was found. The serotype of S. marcescens had no effect on the spheroplast induction rate. Monocations (Na+ and K+) had little effect on spheroplast induction.
A case of renal cell carcinoma with heterotopic bone formation is presented. We will review the reports and radiographic findings of Japanese cases and comment on their hypovascularity.
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