Biomedical subjects
Publications and source records attributed to Y Tada.
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A 25-year-old female with simple virilizing type of congenital adrenocortical hyperplasia due to 21-hydroxylase deficiency was treated surgically with masculinizing operations which consisted of two-stage procedures. The first procedure was chordectomy associated with excision of both gonads and female internal genitalia. Eleven months later, the second procedure consisting of urethroplasty and implantation of testicular prosthesis was performed. The postoperative course was successful in terms of urination and penile erection.
A fusiform thoracoabdominal aortic aneurysm involving celiac, superior mesenteric and renal arteries was successfully replaced in a 53-year-old female with Marfan's syndrome who also had annuloaortic ectasia, dissecting aneurysm of descending aorta and bilateral subclavian arterial aneurysms. Exposure of the aneurysm was obtained with a thoracoabdominal incision by reflecting the abdominal viscera to the right. First the limbs of a 24 X 12mm dacron bifurcated prosthesis were attached to common iliac arteries in an end-to-side fashion. Then renal arteries were anastomosed end-to-end to the branches previously attached to the body of the prosthesis. With the temporary bypass from left subclavian to left limb of the dacron graft, reconstruction of the celiac and superior mesenteric arteries was performed by direct suture of orifices to the opening made in the graft. Proximal anastomosis between descending aorta and the graft was made in an end-to-end fashion. The dissecting lesion of the proximal descending aorta was wrapped by dacron mesh. The immediate postoperative course was uneventful except transient hepatitis and pneumonia. The patient was discharged 49 days after operation. One month later, however, she died suddenly. Autopsy could not reveal the exact cause of death. Retrograde revascularization combined with Crawford's method was useful in shortening the occlusion time.
Clinical course and histological findings of 692 patients with bladder tumor were reviewed to reveal the statistics and clinical profile of carcinoma in situ and its related conditions in the urinary bladder. Primary papillary intraepithelial lesions were found in 83 cases (12.0%), whereas flat intraepithelial carcinoma was found in 16 cases (2.0%), 10 as primary and 6 as secondary tumors. In 35 cases (3.5%), the bladder lesion was flat and rather difficult to find by cystoscopy, and initially considered as chronic cystitis or flat carcinoma in situ. Post-operative histological diagnosis, however, revealed micro- or apparent invasion beyond the basement membrane. Thus they were tentatively classified as clinical carcinoma in situ. The result of the radical surgical treatments for the clinical carcinoma in situ was very poor with a rough 5-year survival of 19%. The management of primary or secondary flat intraepithelial carcinoma was carried out by radical surgery or bladder sparing operation followed by intravesical instillation of cytotoxic agents. The results of these procedures remain uncertain. Some confusion in terminology of carcinoma in situ is discussed and the term "flat carcinoma" was recommended to indicate carcinoma in situ and its related conditions.
A 76 year-old woman visited our university hospital with a complaints of dysphagia of 3 months duration and was discovered to have a right internal carotid aneurysm protruding to the right side of the larynx. A day prior to admission, dysarthria and left hemiparesis occurred with sudden onset. These ischemic attacks spontaneously remitted within 48 hours. A carotid arteriogram showed a saccular aneurysm located high in the right internal carotid artery. Four days after admission, aneurysmectomy with end-to-end anastomosis was carried out with the temporary internal shunt under the induced hypertension. There was no sign of ischemic brain damage after the operation. But she suffered from dysphagia due to the NO. 9, 10, and 12 cerebral nerve palsies, which took 5 months to recover completely. Despite several difficulties in the operation for a highly located internal carotid aneurysm, we emphasize in this report the necessity of aneurysmectomy and the establishment of vascular continuity with the aid of internal shunt to prevent the ischemic brain damage.
A 32-year-old man developed abdominal pain and the paradoxical hypertension after aortic coarctation repair. Abdominal angiography revealed widespread changes of the branches of the superior mesenteric artery and the celiac axis. After the conservative treatment, both the abdominal pain and the angiographic changes disappeared.
Analyses of hormone receptors in cytosols from 41 renal cell carcinoma specimens were performed by the dextran-coated charcoal technique, using estradiol, synthetic progestin R5020 and synthetic androgen R1881. Binding data were calculated according to the method of Scatchard. Of 41 renal cell carcinomas estradiol receptor was detected in 11, R5020 receptor in 11 and R1881 receptor in 13. No significant correlation between histopathological findings and hormone receptors was observed. Patients were classified into those positive and negative for receptors. The clinical response of endocrine therapy for 17 with advanced residual or metastatic lesions after nephrectomy was studied in regard to the survival rates. Although there was no complete or partial regression in tumor size, the survival rate of patients with 1 or more receptors was significantly higher than that of patients negative for receptors (p less than 0.01). In conclusion, hormonal manipulation in patients with renal cell carcinoma cannot induce an antitumor effect but seems to increase survival in patients with receptors.
The chromosomal DNA of Escherichia coli spheroplasts induced by penicillin G was studied biochemically and electron microscopically. Although the spheroplasts were unable to divide, they continued to synthesize chromosomal DNA for several hours even in the presence of penicillin G. Some differences were observed between the chromosomal DNA of the parent cells and that of the spheroplasts in sucrose gradient centrifugation and electron microscopy; two types of chromosomal DNA, a slower sedimenting form and a faster sedimenting form, were released from the gently lysed parent cells. The former was membrane-free folded chromosome and the latter was membrane-associated chromosome. In contrast, the chromosome from the spheroplast showed a single intermediate value of sedimentation coefficient between those of the chromosomal DNA from the parent cell. Cytochrome spreading for electron microscopy showed that the spheroplast chromosomal DNA formed an aggregated mass consisting of several chromosome-molecules of the parent cell.
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The anti-tumor effect of twice a week instillation of 30 mg mitomycin C combined with 200 mg cytosine arabinoside dissolved in 30 ml saline was studied in 37 bladder tumor patients. Endoscopic or histological disappearance of the tumor was observed in 19 cases, average instillation being 16.4 times. Small (less than 1 cm in diameter), low grade, low stage and villous-surfaced tumors were more sensitive to this therapy. Further more, in the cases showing a complete response, frequency of the intravesical tumor recurrence significantly decreased compared with the cases showing no response. The clinical results of this therapy are compared mainly with those of TUR performed at our hospital, and the usefulness and clinical limitation of this kind of management in the treatment of bladder tumors are discussed.
A case of renovascular hypertension in a patient with a congenitally solitary kidney associated with retrocaval ureter is reported. Aortorenal bypass with autogenous saphenous vein graft and concomitant mobilization of the ureter by division and reanastomosis of the inferior vena cava were performed. Pathogenesis of the stenotic lesion of the renal artery was fibromuscular dysplasia. Postoperative improvement of hypertension was not so good as expected. Soon after administration of nifedipine (20mg/day) was started, blood pressure decreased down to 130/80mmHg and had been well controlled. Problems regarding renovascular hypertension with a solitary kidney and surgical treatment of retrocaval ureter are discussed.
An isolated iliac aneurysm is an uncommon entity with a relative incidence to abdominal aortic aneurysm of 0.9 to 1.9 percent. Analysis of 16 cases with 20 isolated iliac aneurysms experienced at our vascular service makes the basis of this report. Seventeen aneurysms involved the common iliac artery, two the internal iliac artery and one the external iliac artery. As we experienced 341 abdominal aortic aneurysms during the same period, relative incidence of isolated iliac aneurysm to abdominal aortic aneurysm was 4.7 percent. Fifteen of the 16 cases were male; isolated iliac aneurysms had significantly higher preponderance for the male. Six of the cases were presented with ruptured aneurysms, giving a rupture rate of 37.5 percent. This rupture rate was significantly higher than that of abdominal aortic aneurysms of 11.1 percent. Operation was performed on 15 patients; the remaining one died before surgery. Although there was no operative death among the elective cases, three patients in the ruptured group died postoperatively giving a mortality rate of 60 percent. The least diameter of the ruptured aneurysms was 3.5 centimeter. Among the 16 patients 5 presented with a ruptured aneurysm and 3 had no symptoms related to the aneurysm. Five patients complained of a pulsatile abdominal mass. Two of the ruptured aneurysms were associated with an iliac arteriovenous fistula. Both of them involved the common iliac artery. Although emergency operation was performed on one of them, he died of acute renal failure due to preoperative dehydration and hypovolemia. The another one was operated on electively after intensive medical treatment for heart failure and the patient survived.(ABSTRACT TRUNCATED AT 250 WORDS)
Ten patients with advanced transitional cell carcinoma were treated with the combination chemotherapy (CISCAF) consisting of cis-platinum (CDDP), cyclophosphamide (CPM), adriamycin (ADM) and 5-fluorouracil (5-FU). There were 8 males and 2 females with a median age of 57 years (range 33-76). Prior to this chemotherapy, all primary lesions were resected surgically; one patient received irradiation, one interferon. CDDP (15 mg/m2) with mannitol diuresis and ADM (7 mg/m2) were given daily for 5 days. CPM (200-300 mg/m2) was given on day one, and 5-FU (200-300 mg/m2) on day 2. Courses were repeated every 3-4 weeks for 3 courses and later every 2 months. All patients were evaluable for toxicity and 9 for response. There were 3 (33%) partial and 2 minor responses. Survival difference between responders (PR + MR) vs non-responders (NC + PD) was significant during the 30-120 days of observation, but not significant throughout the whole period (generalized Wilcoxon test). The overall toxicity due to chemotherapy was generally mild, except for one irreversible nephrotoxicity and one gastric hemorrhage treated surgically.
On August 23, 1982 a 24-year-old woman presented with incontinence following her first delivery. From infancy she used to void urine frequently. When she was 4 years old a left nonfunctioning kidney was diagnosed and left nephrectomy was done. The external genitalia were remarkable in that there was a solitary orifice in the vestibule. The other items in the examination were normal. Vaginal examination revealed that the urethral meatus was on the anterior vaginal wall about 3 cm proximal to its orifice. Bladder neck and proximal urethral narrowing combined with suspension of bladder neck was performed on January 19, 1983. Postoperative course was uneventful and she was continent when the bladder was filled up to 200 ml while she stood erect. Our case might belong to group 3 according to Blum 's classification.
Sympathetic ganglia were dissected from aged patients during surgical operation done for a therapeutic purpose in the University Hospital. Nerve cells were isolated from the ganglia by trituration after incubation with collagenase, and were grown on collagen-coated plastic dishes with a growth medium. These nerve cells regenerated their axons and survived in the tissue culture for more than 3 weeks. The nerve cells tended to reduce the size in an early stage of the in vitro growth.
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To control frequency, urgency and urge incontinence, transcutaneous electrical stimulation was applied to the tibial nerve, the pudendal nerve or the anal sphincter in 79 patients. All patients were refractory to any medications for the control of frequency, nocturia, urgency and urge incontinence from a variety of causes including disk protrusion, Parkinson's disease and idiopathic conditions. The parameters of stimulation were 0.1 to 0.5 msec. duration for each stimulus, frequency 10 to 40 Hz, amplitude 5 to 500 voltage. Cystometrography was repeated during and after electrical stimulation and showed increased bladder capacity, measured at first and/or at maximum desire to void, increased compliance, decreased bladder pressure and/or disappearance of uninhibited contractions in 79% of the patients examined. At least one of these changes was observed in 64, 72 and 85% of the patients who underwent stimulation of the tibial nerve, the pudendal nerve and the anal sphincter, respectively. In some patients inhibition of bladder contraction persisted for more than 2 or 3 days after stimulation. Electromyographic activity of the pelvic floor muscles increased in all of the patients during the stimulation of the pudendal nerve or the anal sphincter, but did not increase and rather decreased during stimulation of the tibial nerve. Urethral pressure measured during electrical stimulation, did not change in many cases. Clinical success was also obtained in 19 of 22 patients who underwent two electrical stimulation program; one was continuous daily use of a portable stimulator, and the other was periodic anal stimulation once or twice a week.(ABSTRACT TRUNCATED AT 250 WORDS)