[Submuscular Nuss procedure using mammary areola incision for adult pectus excavatum with significant upper chest depression].

Submuscular Nuss procedure using mammary areola incision was performed on adult pectus excavatum. The skin was incised approximately 3 cm (almost half the entire areolar circumference). The subcutaneous tissue and pectoralis major muscle were incised to reach the 4th rib. The pectoralis major muscle and serratus anterior muscle were separated from the costae and intercostal muscle. A part of the 3rd intercostal muscle was removed. The sternum and cartilages were robust; therefore the anterior chest wall was elevated with a jack allowing Nuss procedure. After fixing a bar, a drainage tubes were placed beneath the bilateral pleural cavity and muscular layer. Then, the pectoralis major muscle was sutured and the subcutaneous tissue was closed with 2 layers of suturing. The skin was closed with 6-0 nylon sutures, leaving no obvious scar. The mammary areola incision which is used for breast cancer can also successfully applied to Nuss procedure. The Nuss procedure using mammary areola incision is recommended for pectus excavatum with upper chest depression.

Corticotropin-releasing factor type-1 receptor mRNA is not induced in mouse hypothalamus by either stress or osmotic stimulation.

In rats, acute stress substantially increases corticotropin-releasing factor (CRF) type 1 receptor (CRFR-1) mRNA expression in the paraventricular nucleus (PVN) and osmotic stimulation induces both CRF and CRFR-1 mRNA in magnocellular PVN and supraoptic nucleus (SON). However, these phenomena have not been analysed in other species. We compared CRF and CRFR-1 expression in rat and mouse hypothalamus. Male C57BL/6 mice and Wistar rats were exposed to acute restraint stress for 3 h, or to hypertonic saline ingestion for 7 days. Restraint stress increased CRF and c-fos mRNA expression in both rat and mouse PVN. CRFR-1 mRNA was barely detectable in controls, whereas restraint stress substantially increased CRFR-1 mRNA in rat PVN, but not in mouse. Hypertonic saline ingestion induced CRF mRNA in magnocellular PVN and SON of the rat, but did not alter CRF mRNA levels in mouse hypothalamus. CRFR-1 mRNA was also induced in magnocellular PVN and SON of the rat in response to osmotic stimulation, but not in mouse. Immunohistochemistry demonstrated that CRFR-1-like immunoreactivity (ir) was distributed within parvocellular and magnocellular PVN of mouse and rat. CRFR-1-ir in rat PVN was increased by acute stress and osmotic stimulation. By contrast, these treatments did not alter CRFR-1-ir in mouse PVN. Combined immunohistochemistry and in situ hybridization revealed that CRFR-1-ir was most frequently colocalized to CRF in mouse PVN, whereas only a small percentage of oxytocin and vasopressin-producing cells coexpressed CRFR-1-ir. These results indicate that (i) by contrast to rats, neither acute stress nor osmotic stimulation induces CRFR-1 mRNA expression in the mouse PVN; (ii) osmotic stimulation does not alter CRF mRNA expression in parvocellular and magnocellular neurones of mouse PVN; and (iii) acute stress increases c-fos and CRF mRNA to a similar degree in mouse and rat PVN. Thus, differences may exist between mouse and rat in the regulation of CRF and CRFR-1 gene expression in hypothalamus following stress and osmotic stimulation.

Involvement of cAMP-response element binding protein in corticotropin-releasing factor (CRF)-induced down-regulation of CRF receptor 1 gene expression in rat anterior pituitary cells.

Corticotropin-releasing factor (CRF) is a major secretagogue of adrenocorticotopic hormone from the anterior pituitary and a key activator of the hypothalamic-pituitary-adrenal axis. We previously reported that CRF down-regulates expression of the CRF type-1 receptor (CRF-R1) mRNA in cultured rat anterior pituitary cells. The present study was conducted to clarify the signal transduction systems involved in CRF-induced down-regulation of CRF-R1 gene expression in the anterior pituitary. Northern blot analysis revealed that, under serum-free conditions, 10 nM CRF decreased CRF-R1 mRNA levels in cultured rat anterior pituitary cells as we reported previously. Treatment with 5 mM 8-Br-cAMP reduced CRF-R1 mRNA levels within 2 h. The mRNA level fell to 37+/-3% of the basal level at 2 h and remained low for 16 h after treatment. This CRF-induced reduction of CRF-R1 mRNA expression was inhibited completely by pretreatment with protein kinase A (PKA) inhibitor (1 microM H-89). Further examination revealed that after pretreatment with 10 microM of antisense oligodeoxynucleotide for cyclic AMP-response element binding protein (CREB), the CRF-induced inhibition of CRF-R1 mRNA was partially decreased to 79+/-4% of the control level 2 h after administration of CRF. These findings indicate that CRF may down-regulate CRF-R1 mRNA expression via a cAMP-PKA-mediated mechanism in rat anterior pituitary cells, and that CREB may mediate at least a portion of this inhibitory effect.

Flash-related synchronization and desynchronization revealed by a multiple band frequency analysis.

The fast Fourier transform (FFT) is a good method to estimate power spectral density (PSD), but the frequency resolution is limited to the sampling window, and thus the precise characteristics of PSD for short signals are not clear. To relax the limitation, a multiple band-pass filter was introduced to estimate the precise course of PSDs for flash visual evoked potentials (VEPs). Signals were recorded during -200 and 600 ms using balanced noncephalic electrodes, and sampled at 1,000 Hz in 12 bits. With 1 Hz and 10 ms resolutions, PSDs were estimated between 10 and 100 Hz. Background powers at the alpha- and beta-bands were high over the posterior scalp, and powers around 200 ms were evoked at the same bands over the same region, corresponding to P110 and N165 of VEPs. Normalized PSDs showed evoked powers around 200 ms and suppressed powers following the evoked powers over the posterior scalp. The evoked powers above the 20 Hz band were not statistically significant, however, the gamma band was significantly evoked intra-individually; details in the gamma bands were varied among the subjects. Details of PSDs were complicated even for a simple task such as watching flashes; both synchronization and desynchronization occurred with different distributions and different time courses.

Malignant neurofibroma of the urinary bladder.

Malignant neurofibroma of the urinary bladder is a very rare entity and usually associated with von Recklinghausen's disease. We present the first case of sporadic malignant neurofibroma of the urinary bladder and a review of the literature.

[Xanthogranulomatous epididymitis. A case report].

A 45-year-old man with spinal injury and diabetes mellitus who complained high fever and progressive enlargement of left intrascrotal mass visited to our hospital. Preoperative ultrasonography demonstrated epididymitis and abscess formation. Left high orchiectomy was performed because testicular tumor could not be denied. Epididymis was replaces by bright yellow mass associated with abscess and adhered to testis strongly. Histopathologically, the mass diagnosed xanthogranulomatous epididymitis consisted of foamy macrophages and chronic inflammatory cells. This is the first case in Japanese medical literature.

Prediction of alpha-blocker response in men with benign prostatic hyperplasia by magnetic resonance imaging.

OBJECTIVES: To assess the value of magnetic resonance imaging (MRI) for predicting the alpha-blocker response in men with symptomatic benign prostatic hyperplasia (BPH) and to examine the relationship between MRI and the area density of smooth muscle cells in BPH. METHODS: Twenty-eight men were consecutively enrolled in this study and received tamsulosin 0.2 mg once daily for 4 to 6 weeks. The efficacy of tamsulosin was determined by measuring improvements in the maximum urinary flow rate (Qmax) and International Prostate Symptom Score (IPSS). The patients underwent T2-weighted MRI and were separated into a high (H) or iso-low (IL) group according to the signal intensity of the inner gland of the prostate compared with that of bone marrow of the proximal femur head. The area density of smooth muscle cells was determined using immunostaining with antiactin antibody in 16 prostate specimens. RESULTS: IPSS significantly decreased after the administration of tamsulosin from 16 +/- 1 to 8 +/- 1 (n = 28, P <0.0001 ), and 76.7% of the patients had an improved IPSS of 25% or greater. Qmax was significantly increased in group IL (P = 0.03) but not in group H. Of the patients in group IL, 53.3% had a Qmax response (an increase of Qmax of 30% or more); 15.4% did so in group H (P = 0.04). The area density of smooth muscle cells was 48.1 +/- 3.7% in group IL (n = 9) and 36.7 +/- 3.2% in group H (n = 7, P = 0.04). CONCLUSIONS: MRI is useful in estimating the area density of smooth muscle cells in the prostate and in predicting Qmax response for alpha-blocker therapy in patients with symptomatic BPH.

Simple technique of ligation and division of dorsal vein complex during radical retropubic prostatectomy.

A simple technique for ligation and division of the dorsal vein complex during radical retropubic prostatectomy is described. The dorsal vein complex and anterior wall of the membranous urethra were collectively ligated with a "theta theta" suture using 1-0 catgut and then divided during radical retropubic prostatectomy. This technique prevents dislodgment of the catgut during the procedure, enables maximal preservation of the striated urethral sphincter, and guarantees a lower risk of postoperative urinary incontinence.

Renal needle biopsy along the retrograde puncture line of the renal calyx: a new promising technique.

The Biopty-gun is a useful tool in conducting percutaneous renal biopsies, but bleeding is still a significant complication. To reduce the rate of severe bleeding complications, we attempted a new method of renal needle biopsy using a retrograde access technique. Retrograde puncture of the renal calyx was performed using the Lawson nephrostomy kit. The 18-gauge needle of the Bioptygun was inserted along the puncture wire and fired. A 7-french pigtail catheter was retained in the renal pelvis for a few days following the procedure. This biopsy is a promising and safe technique.

A simple technique for vesicourethral anastomosis in retropubic radical prostatectomy.

Vesicourethral anastomosis during radical retropubic prostatectomy is often difficult. We present a new simple technique using a Nélaton catheter to aid in accurate suture placement for vesicourethral anastomosis.

Appropriate intravenous doses of L-thyroxine and magnesium in a thyroidectomized patient with thyroid and parathyroid carcinomas receiving total parenteral nutrition during acute necrotizing pancreatitis.

A totally thyroidectomized patient with thyroid and parathyroid carcinomas, which had developed after neck irradiation in childhood, became hypercalcemic due to pulmonary metastases. The hypercalcemia was ameliorated by intermittent iv administration of bisphosphonate for 3.5 years, but this gradually became refractory to the bisphosphonate treatment. After right thoracotomy for resection of pulmonary metastases, acute necrotizing pancreatitis developed. The patient was therefore placed on total parenteral nutrition supplemented with T4 and a restricted dose of magnesium. Thyroxine(T4) (30 micrograms/day, iv) was not sufficient to maintain euthyroidism, but a higher dose (60 micrograms/day) elicited mild hyperthyroidism to the same extent as that elicited by an oral dose of 100 micrograms/day. The present case showed that the appropriate iv dose of T4 in this thyroidectomized patient with acute pancreatitis was about 60% of the oral dose. Furthermore, bisphosphonates (pamidronate and alendronate) and magnesium depletion were very effective in controlling the hypercalcemia.

[Bilateral spermatocele developed after vasectomy: a case report].

A rare case of bilateral spermatocele developed 17 years after vasectomy was presented. A forty-seven year old man visited to our hospital with a chief complaint of swelling of bilateral intrascrotal contents. Sonographic findings demonstrated multilocular lesions of the bilateral intrascrotal contents. Operative procedure revealed bilateral cysts originating from the caput of the epididymis. Bilateral epididymectomy were performed. It was diagnosed as spermatocele because of demonstration of spermatozoa in the cystic fluid. We concluded that bilateral spermatocele has been induced by prolonged increased pressure of the intraepididymal duct following vasectomy 17 years ago.

PIP: A rare case of bilateral spermatocele, which developed 17 years after vasectomy, is presented. A 47-year-old man visited the hospital with a complaint of swelling of the bilateral intrascrotal contents. Sonographic findings demonstrated multilocular lesions of the bilateral intrascrotal contents. A surgical procedure revealed bilateral cysts originating from the caput of the epididymis. Bilateral epididymectomy was performed. This case was diagnosed as spermatocele because of the demonstration of spermatozoa in the cystic fluid. It was concluded that the bilateral spermatocele was induced by prolonged increased pressure in the intraepididymal duct due to increased sexual activity over a long period of time following vasectomy.

Corticotropin-releasing factor-binding protein concentrations in plasma of patients with hypothalamic-pituitary-adrenal disorders.

Immunoreactive corticotropin-releasing factor-binding protein (CRF-BP) concentrations in human plasma were determined by means of radioimmunoassay for human CRF-BP. CRF-BP antiserum to the C-terminal fragment of human CRF-BP (298-322) was produced, and CRF-BP (298-322) was used as the tracer and the standard. Large amounts of human CRF did not affect measurement of plasma CRF-BP with this radioimmunoassay. The basal plasma CRF-BP concentration in normal subjects was 4.19 +/- 0.57 nmol/L (mean +/- SD). The CRF-BP concentration was low in patients with Cushing's syndrome, except those with preclinical Cushing's syndrome, and high in patients with Addison's disease, hypopituitarism and isolated ACTH deficiency. After surgery, the plasma CRF-BP concentration in patients with Cushing's syndrome rose, peaked, and then decreased to the control level. In patients with Addison's disease, the high plasma CRF-BP concentration decreased to the control level after hydrocortisone replacement, the same as plasma ACTH concentration. These findings suggest that the immunoreactive CRF-BP concentration in human plasma was decreased by glucocorticoids, at least under chronic conditions.

Central administration of alpha-melanocyte-stimulating hormone inhibits corticotropin-releasing factor release in adrenalectomized rats.

To determine if there is a short negative feedback effect of hypothalamic ACTH-related peptides on corticotropin-releasing factor (CRF) release in vivo, we examined the effect of cerebroventricular injection of alpha-melanocyte-stimulating hormone (alpha MSH) on ACTH levels in plasma and the anterior pituitary and CRF levels in the median eminence of the hypothalamus in adrenalectomized or sham-operated rats under pentobarbital anesthesia. alpha MSH did not affect basal ACTH or CRF levels in sham operated rats. However, elevated plasma ACTH levels and CRF levels in the median eminence were decreased by central administration of alpha MSH in adrenalectomized rats. These results suggest that there is a short negative feedback effect of alpha MSH on CRF release and it appears only in the absence of a long negative feedback effect of glucocorticoids.

[Re-operation of pectus excavatum].

We performed surgical reconstruction on 1655 cases of deformed thoracic cage, we later operated again on 11 of these to repair postoperatively re-deformed anterior chest walls. Based on these experiences, we have concluded as follows. 1: Postoperative recurrence of funnel chest deforming is mainly due to insufficient resection of costal cartilages. In particular transection of the sternum at low levels during sternal turn-over procedure results in postoperative recurrence of depression in the upper anterior chest wall. 2: In young children who have undergone sternal turn-over procedure, the first and second costal bones and cartilages overgrow and protrude anteriorly, and in compensation their junctions to the sternum recess posteriorly. This results in a depression in the upper anterior chest wall. 3: We recommend sternal turn-over with overlapping of the sternum for repair of postoperative funnel chest deformity. Through this procedure, the extent of resection of costal cartilages can easily be determined and the depression of the anterior chest wall satisfactorily reconstructed. 4: In re-do surgery, we obtained pathological evidence confirming our clinical experience that our sternal turn-over technique does not interfere with blood circulation or development of the turned-over sternum even though the sternum is not connected to the rectus abdominus muscle pedicle, preserved internal mammary vessels, or anastomosis of the internal mammary vessels.