Effect of pregnancy on lower limb lymphedema in patients treated with multisite lymphaticovenular anastomoses (MLVAS).

Lymphaticovenular anastomosis (LVA) using supermicrosurgical techniques is effective for treating and preventing progression of lymphedema. We analyzed the influence of pregnancy on LVA in five patients from a total 2179 LVA cases. Previous studies offer conflicting reports on whether pregnancy worsens pre-existing lymphedema. This is the first report on the influence of pregnancy on lower limb lymphedema previously treated by multisite LVA (mLVA). Five patients with primary (n=4) and secondary (n=1) lower leg lymphedema were analyzed for this study. Patient age ranged from 18 to 31 (average 22.6) years old with 4 right and 1 left extremities involved. Duration of symptoms ranged from one to 19 (average 7.4) years and the periods of compression therapy were from 1 to 19 years (6.6 years). Four patients had single pregnancies and one patient was multiparous with 3 pregnancies. Final follow-up ranged from 5.8 to 18 years (average 8.9 years) after the primary mLVA. All patients had normal pregnancy, birth, and no serious complications after surgeries. Following pregnancy three patients had complete functional recovery (limb volume reduction and no compression requirement), one with functional improvement (limb volume reduction but required compression), and one with no change in symptoms (not worse and continued need for compression). There were no occurrences of infection following pregnancy. Based on this case series, it is suggested that pregnancy does not worsen the pre-existing lymphedema in patients who had previously undergone mLVA. Further studies with larger number of patients are needed to confirm these results.

Curcumin ameliorates streptozotocin-induced liver damage through modulation of endoplasmic reticulum stress-mediated apoptosis in diabetic rats.

We investigated the effect of curcumin on liver injury in diabetic rats induced by streptozotocin (STZ) through modulation of endoplasmic reticulum stress (ERS) and unfolded protein response (UPR). Experimental diabetes was induced by a single intraperitoneal injection of STZ (55 mg/kg), and curcumin was given at 100 mg/kg by gavage for 56 days. We observed that curcumin improved the morphological and histopathological changes, significantly decreased hepatic ERS marker protein: glucose-regulated protein 78, and improved liver function in diabetic rats. Moreover, treatment with curcumin markedly decreased the sub-arm of the UPR signaling protein such as phospho-double-stranded RNA-dependent protein kinase-like ER kinase, CCAAT/enhancer-binding protein homologous protein, tumor necrosis factor receptor-associated factor 2, and inositol-requiring enzyme1α; and inhibited tumor necrosis factor α, interleukin 1ß, phospho-p38 mitogen-activated protein kinase, and apoptosis signal-regulating kinase 1 in liver tissues of diabetic rats. Apoptotic and anti-apoptotic signaling proteins, such as cleaved caspase-3 and B-cell lymphoma 2, were significantly increased and decreased, respectively in diabetic rats; curcumin treatment prevented all of these alterations. In summary, our results indicate that curcumin has the potential to protect the diabetic liver by modulating hepatic ERS-mediated apoptosis, and provides a novel therapeutic strategy for the diabetic liver damage.

[Urethral injury with unusual clinical course: a case report].

A 20-year-old men fell from a ladder in 1995, striking his perineum strongly, and macroscopic hematuria with painful urination lasted for several days. Subsequently, swelling of the perineum on urination continued to occur. However, he did not seek medical treatment until July 1997, when he consulted our medical institution. A diverticulum-like change was found in the bulbous urethra on urethrocystography, and a tear in the same position on urethroscopy. On September 22, 1997, surgery was performed after constructing a cystostomy, the tear was located using a urethroscope, and closed through a perineal approach. At 14 days after surgery, there was extra-urethral leakage of contrast media on voiding cystourethrography, and at 28 days after surgery, the findings showed improvement. Since then, he has been free of the preoperative symptoms.

[A case of synchronous triple primary cancers of prostate, kidney and bladder].

A case of synchronous triple primary cancer occurring in the prostate, kidney and urinary bladder is reported. A 74-year-old man had been complaining of macroscopic hematuria, dysuria and residual sensation of urine since January 1994. Pathological analysis of prostate revealed poorly differentiated adenocarcinoma in March, 1994. Bone and Ga scintigraphy gave no evidence of metastasis. Computerized tomography (CT) revealed irregularity of a part of the margin of prostate (T2N0M0) and enhanced mass with a diameter of 3 cm localized at the hilus of the right kidney. Excretory urography showed a shadow defect in the right pelvis and elevation of the bladder base. In spite of the appearance of class 5 in urine cytology, no tumor was detected in the bladder by cystoscopy. Angiography confirmed the presence of a hypervascular tumor in the right kidney. He underwent right-sided nephroureterectomy in April, 1994, because not only right pelvic tumor but also right renal tumor was suspected. Histological examination of the renal tumor revealed clear cell carcinoma (T2N0M0). Then, he did not visit our hospital for 8 months. In January, 1995 a papillary broadbase tumor was found near the bladder neck by cystoscopy. Transurethral resection of the tumor (TUR-Bt) was performed in February, 1995. Pathological analysis of the tumor revealed TCC G1 pT1 (T1N0M0).

[Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone].

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1,701 patients in a total of 2,438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1,200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

[Transrectal hyperthermia for benign prostatic hyperplasia].

Transrectal hyperthermia was performed on 30 patients with benign prostatic hyperplasia twice a week for a total of ten times with the temperature of the prostatic tissue set at 43.0 degrees C. In our in vitro experiment using an agar phantom, the highest temperature was observed at approx. 1.5 cm from the point where the 915-MHz microwave was generated. Our histopathological study of the prostatic tissue, resected at open surgery after three days of hyperthermia, indicated that the effect of hyperthermia first occurred in the interstitial tissues, and then extended to the epithelial cells. Subjective symptoms and objective findings were evaluated. In almost all cases, improvement was observed in subjective symptoms after completion of the treatment. The residual urine volume improved significantly. Also, significant improvement was observed in our urodynamics study. In 16 out of 30 cases (53%), both subjective symptoms and objective findings were still improved after six months.

[Transurethral balloon dilatation of the prostate: initial results, indication and complication].

Transurethral balloon dilatation therapy was performed on 40 patients with benign prostatic hypertrophy (BPH) under local anesthesia. During the procedure, urinary urgency occurred in 80% of the patients. After prostatic dilatation, macrohematuria was observed in almost all patients. The longest follow-up period after dilatation was now 22 months, and the average was 9.5 months. After treatment, residual urine volume decreased, and average flow rate and maximal flow rate improved from 5.7 and 10.4 ml/sec to 8.2 and 15.6 ml/sec, respectively. Overall clinical efficacy was 67.5%. Urethral dilatation therapy was thought to be an effective and non-invasive therapy for BPH.

[Clinical study of risk factors concerning arteriosclerosis of the patients undergoing hemodialysis].

To study the risk factors of arteriosclerosis of the patients undergoing hemodialysis, aortic pulse wave velocity (PWV) was measured in 42 patients (26 male and 16 female) undergoing hemodialysis. The relationships were examined between PWV value and various risk factors, such as age, blood pressure, serum lipid level and aortic calcification index (ACI). PWV value was elevated with age and it was higher in the patients group than the age-matched control subjects. There was a statistically significant correlation between PWV value and blood pressure. The effect of elastase on PWV value was found in the patients with high PWV value (over 9.0 m/sec). However, no correlations were found between PWV value and serum lipid level such as total cholesterol, triglyceride, HDL-cholesterol and beta-lipoprotein. On the other hand, PWV value was changeable according to ACI and this relationship was statistically significant (p less than 0.01). These results suggested that aortic calcification could be one risk factor for arteriosclerosis of the patients with chronic renal failure undergoing hemodialysis.

[A case of asynchronous triple primary malignant tumors of bladder, stomach and lung].

An asynchronous case of triple primary malignant tumors of bladder, stomach and lung was reported. The patient was treated by total cystectomy and ileal conduit plasty for a bladder tumor in 1978 and subtotal gastrectomy and Billroth-I plasty for a gastric cancer in 1984. In 1987, a lung cancer was found and the biopsy revealed a small cell carcinoma. Though combined chemotherapy was done, he died from the lung cancer 2 years later. Fulfilling the Warren and Gate's criteria, this case may be said to be an asynchronous case of triple primary cancers.

Morphological change and Raman spectrum of rabbit lens irradiated with ultraviolet laser beam.

The effect of ultraviolet rays on eyes was studied. An ultraviolet laser beam (XeCl 308 nm) was irradiated to rabbit eyes to investigate morphological changes of the lens fibers and molecular structural changes of the lens proteins at immediately, 15 days and 32 days after irradiation. 1. Scanning electron microscopic findings of the lens The lens fibers in the control eye were regularly and densely arranged in neat layers of hexahedrons. In the irradiated eye, the fibers at areas that seemed injured were disrupted and the disrupted ends were spherical-shaped. 2. Raman spectra of the lens 1) The relative intensity ratio (I825/I850) of the Raman scattering for the tyrosine residue and the relative intensity ratio (I3390/I2960) of the OH stretching mode (3390 cm-1) of water contained in the lens cortex showed slight changes in the irradiated eye compared to the control eye. 2) The relative intensity ratio (I2572/I2721) of the SH stretching mode (2572 cm-1) for the cysteine residue was 1.05 in the irradiated eye at 32 days after irradiation. It was lower than that in the control eye (1.22 +/- 0.08). This suggested the synthesis of S-S binding by oxidization.

[Effects of ultraviolet laser beam irradiation on rabbit cornea and lens].

Rabbit eyes were irradiated by an ultraviolet laser beam in with to investigate its effects on the corneal endothelium, thickness of the cornea, and lens. An Excimer laser beam (gas; XeCl) with wave length of 308 nm and with energy intensity of 0.02, 0.07, 0.2, 0.6, 1.7, 3.0, 4.0, or 5.1 J/cm2 was irradiated to the right eye using 3 rabbits for each energy intensity (24 rabbits in all) in order to examine changes occurring in the right eye compared with the left eye from immediately after irradiation to 32 days thereafter. The results obtained were as follows: 1. Corneal thickness UV laser beam irradiation at 0.02, 0.07, and 0.6 J/cm2 caused immediate thickening of the cornea (p less than 0.01). The cornea thickness returned to normal 14 days later. Irradiation at 3.0 and 4.0 J/cm2 resulted in remarkable thickening, which returned to normal 28 days after irradiation. By irradiation at 5.1 J/cm2, the corneal thickness increased markedly (0.333 +/- 0.019 mm in control eyes and 0.405 +/- 0.05 mm in irradiated eyes) immediately after irradiation. It tended to gradually return to normal and was reduced to the pre-irradiation thickness on the 32nd day after irradiation. 2. Corneal endothelial area and morphology (the number of angles) The area of the corneal endothelium increased after irradiation. However, no significant differences were noted at any energy intensity, because of the larger scattering of the values in the control eyes. The ratio of hexagonal cells tended to decrease even by energy intensities above 0.7 J/cm2. However, no significant differences were found at any energy intensity level.(ABSTRACT TRUNCATED AT 250 WORDS)

Pupillary changes due to work using visual display terminals.

In order to measure the degree of ocular fatigue and general fatigue among the workers using visual display terminal (VDT), pupillary dynamics were measured with open-loop light stimulation for 26 subjects of a mean age of 25.9 years. VDT loads were TV games for 30 min under indirect light of 100 lux. The eight parameters of pupillary light reflex with open-loop pupillometer were examined before and after VDT loads. On the right eyes, two parameters and one value increased 9.2% (Student's t-test: P less than 0.005, max.), 25.7% (Student's t-test: P less than 0.005, Min.) and 14.8% (Student's t-test: P less than 0.005, min/max) just after the load and then gradually decreased and returned to the pre-load level after a 10 to 15-min rest period. Two parameters increased 11.7% (Student's t-test: P less than 0.05, 1/2C) and 12.9% (Student's t-test: P less than 0.05, VD), one parameter decreased -9.0% (Student's t-test: P less than 0.05, 0.63D) and three parameters were constant (Student's t-test: L, A and VC) just after the load. On the left eyes, the same tendencies were observed. But there were no significant differences (Student's t-test) between the right and left eyes. The change pattern of the eight parameters were small in degree and similar to the changes when the sympathetic nervous system was activated.