[Rapidly enlarging giant left ventricular pseudo-false aneurysm after myocardial infarction; report of a case].

A 71-year-old man was admitted to our hospital with acute myocardial infarction and cardiac tamponade. After pericardial drainage, his hemodynamics was improved. Because more than 3 days had been passed after the onset of myocardial infarction and he had severe renal dysfunction, emergent coronary angiography (CAG) was not performed. After improvement of his general status, coronary angiography and percutaneous catheter intervention was carried out, and his course was uneventful. But transthoracic echocardiography before discharge revealed a giant posterior psudoaneurysm. Patch closure and coronary artery bypass grafting was carried out under cardiopulmonary bypass, and postoperative course was uneventful. Postoperative left ventriculogram revealed disappearance of pseudoaneurysm, but relatively large akinetic area of posterior-inferior wall was left around a patch. Pseudo-false aneurysm was diagnosed by histological examination.

The relationship between technical parameters of external beam radiation therapy and complications for localized prostate cancer.

BACKGROUND: This study was performed to review retrospectively the clinical course of chronic rectal bleeding as a complication of external beam radiation therapy for localized prostate cancer and to analyze the relationship between technical parameters of radiation therapy and the complications. METHODS: Seventy-one patients with stages A2, B and C were treated with local-field radiotherapy (total dose 52.5-66 Gy, daily dose 2.0-3.28 Gy, field area 30-81 cm2, number of fields 3-15 ports, planning simulations X-ray or CT-based) between 1989 and 1998 at three institutions. The protocols were consistent during this same period at these institutions. RESULTS: Multivariate analysis revealed pretreatment PSA and Gleason sum to be statistically significant predictors of 5 year prostatic specific antigen (PSA) relapse-free rates in a median follow-up period of 42 months (range 12-119 months). The significant risk factors for higher grading of acute morbidity were a biological equivalent dose, alpha/beta = 10(BED10) > or =65 Gy, dose per fraction > or =3.0 Gy, field area > or =42 cm2, fewer ports and X-ray planning simulation. However, no parameter was associated with higher grading of late morbidity. Eleven patients (15.4%) experienced a late GI complication: grade 1 (4.2%), grade 2 (9.8%), grade 3 (1.4%). The median time to occurrence of rectal bleeding was 12 months after radiotherapy and the mean duration of morbidity was 11 months. CONCLUSIONS: Higher total dose and dose per fraction, larger field area, fewer ports and X-ray simulation increased the grades of acute morbidity. A majority of chronic rectal bleedings were transient and responded to conservative treatment.

Acute renal failure occurring from urinary retention due to a müllerian duct cyst.

A patient with a müllerian duct cyst, which caused acute renal failure secondary to urinary retention, is reported. The case was treated successfully by transurethral unroofing of the cyst.

[The natural history of renal angiomyolipoma].

PURPOSE: To make the policy of treatment with angiomyolipomas (AML) more clear, we discussed the natural history of angiomyolipomas retrospectively. PATIENTS AND METHODS: Between May 1982 and December 1997, 14 patients with AML in 18 kidneys were followed, who were 2 men in 2 kidneys and 12 women in 16 kidneys, 27 to 80 years old. No patients suffered from tuberous sclerosis. Symptoms, initial sizes and changes of the size were evaluated for these patients. RESULTS: Ten patients with AML in 14 kidneys were asymptomatic and four patients were symptomatic. But one of the 4 patients had symptoms of abdominal pain and palpable mass which were due to contralateral AML that were treated with nephrectomy, so symptoms due to small AML were seen in 3 cases (2.0 cm, 3.5 cm, 3.8 cm). Among 11 patients in 15 kidneys followed radiologically for more than 6 months, the tumors were unchanged in size in 7 kidneys, which were in all of 6 cases with unilateral solitary tumor and in 1 with bilateral multiple tumors. In other 8 kidneys the sizes of the tumors were increased, which were in the cases with multiple tumors in one kidney or in bilateral cases. Compared to the cases of unilateral solitary AML, the size of AML with multiple tumors in one kidney or in bilateral kidneys significantly increased (p < 0.01). Embolization were performed for 4 kidneys, which were in 2 cases with increased tumor in size to more than 4 cm in following period, in 1 with dull flank pain, and in 1 with the tumor more than 4 cm at diagnosis that grew to more than 5 cm. CONCLUSIONS: Unilateral solitary AML was appeared to be hard to increase in size and to have a different natural history from bilateral or multiple tumors.

Abnormal structure of the Y chromosome detected in bovine gonadal hypoplasia (XY female) by FISH.

The structure of the Y chromosome was investigated by FISH and G banding in 3 cases of bovine XY females shown by PCR to lack the SRY gene. Although 2 different repeat-DNA sequences (BC1.2 and btDYZ-1) hybridized to the short arm of the Y chromosome in a normal bull, they hybridized to both arms of the Y chromosome in the XY females. In the Y chromosome from XY females, only the centromeric region was darkly stained by G banding, in comparison with dark staining on the long arm of a normal Y chromosome. From the results obtained, it seemed that the Y chromosome from the XY females was structurally abnormal, namely an isochromosome with an identical short arm. Our results also confirm that SRY is located on the long arm of the Y chromosome in bovine.

Isolation of a germline-transmissible embryonic stem (ES) cell line from C3H/He mice.

We have isolated three embryonic stem (ES) cell lines from C3H/He mice using mouse STO cells as a feeder layer. One ES cell line (H-1) was male, and two (H-2 and H-3) were female, as determined by polymerase chain reaction, in situ hybridization, and karyotype analyses. All were immunocytochemically reactive with a C3H strain-specific antibody. Injection of cells from the female ES H-3 line into C57BL/6 blastocysts yielded four chimeras with slight coat color chimerism. All chimeras were male, and as expected, no germline-transmission was observed. By contrast, when male ES H-1 cells were injected into the perivitelline space of 8-cell C57BL/6 embryos, one male mouse with overt coat color chimerism was recovered, and it produced ES H-1-derived offspring exclusively. This germline-transmissible C3H/He cell line represents a novel addition to those ES lines currently employed for gene manipulation studies of development.

Deletion of the SRY region on the Y chromosome detected in bovine gonadal hypoplasia (XY female) by PCR.

In 6 sterile heifers which were female in appearance and in genital organs, all tissues derived from blood, skin, spleen and kidney had a single 60,XY type of metaphase plate. Although the SRY gene was detected by PCR in normal bull, it was not detected in normal cow or in 3 60,XY cases studied.

A fast, convenient diagnosis of the bovine freemartin syndrome using polymerase chain reaction.

To establish the polymerase chain reaction (PCR) method for detecting the XY cells in cases suspected to have the bovine freemartin syndrome, a PCR reaction test was conducted on blood from a normal bull diluted in blood from a normal cow. From the results obtained, it was shown that the Y-specific sequence was detectable down to a concentration of 0.1%. Various types of the bovine freemartin syndrome, which occurs in heterosexual twins, single-born sterile heifers, and heifers born with Acardius amorphus, were examined by the chromosome analysis and the PCR method. The Y-specific sequence was detected in all 26 cases that showed chromosome chimerism but which was absent in the 5 cases without a chimerism. The PCR method was found to be effective and convenient for quickly diagnosing the various types of bovine freemartin syndrome.

Minute fragment observed in a bovine pedigree with Robertsonian translocation.

A minute fragment was found in the metaphase plates obtained from one Holstein bull carrying Robertsonian translocation. The pedigree investigation indicated that three out of 34 offspring had the same minute fragment as their sire. Fluorescence in situ hybridization (FISH) studies with bovine satellite DNA revealed that the minute fragment was hybridized with this DNA and was part of the bovine centromere. We propose that the minute fragment is the product of centric fusion and is transmitted to offspring without being lost in the subsequent cell divisions.

Prophylactic chemotherapy for primary and recurrent superficial bladder cancer: preliminary results. The Hokkaido University Bladder Cancer Collaborating Group.

A multicenter trial for postoperative prophylaxis of the recurrence of superficial Ta-T1, G1-G2 bladder cancer was performed. Eligible patients with primary or recurrent superficial bladder cancer were randomized into four groups. For the primary cases, intravesical instillation of drugs [group A, 20 mg Adriamycin (ADM) + 200 mg cytosine arabinoside (CA) in 30 ml physiological saline; group B, 10 mg peplomycin (PEP) + 200 mg CA in 30 ml physiological saline; group C, 2 mg neocarzinostatin (NCS) + 200 mg CA in 30 ml physiological saline; and group D, control] was carried out once a week for 2 weeks, once every 2 weeks for 14 weeks, once monthly for 8 months, and, finally, once every 3 months for 1 year. For the recurrent cases, intravesical instillation of 20 mg ADM + 200 mg CA in 30 ml physiological saline as described above and daily oral administration of another drug [group E, 300 mg/day UFT; group F, 200 mg 5-fluorouracil (5-FU)/day; group G, 30 mg ubenimex/day; and group H, no oral drug] was performed. The postoperative follow-up period was 3-36 months. A total of 193 primary cases and 121 recurrent cases of superficial bladder cancer were evaluated. The cumulative 12-month nonrecurrence rates for the primary cases were 86.2% in group A, 78.1% in group B, 82.1% in group C, and 68.4% in group D. The cumulative nonrecurrence rate obtained using ADM+CA (group A) was significantly higher than the control value. On the other hand, no significant difference was found in the cumulative nonrecurrence rates calculated for the recurrent cases, regardless of the oral drug given. Intravesical instillation of ADM+CA for primary superficial bladder cancer was considered to be useful, but the long-term effect of intravesical instillation remains to be elucidated. Further refinement of this regimen is necessary for effective prophylaxis of the recurrence of superficial bladder cancer.

Effects of a membrane-bound trypsin-like proteinase and seminal proteinase inhibitors on the bicarbonate-sensitive adenylate cyclase in porcine sperm plasma membranes.

Plasma membranes were purified from flagella of porcine cauda epididymal sperm and proteolytic regulation of bicarbonate-sensitive adenylate cyclase was studied. It was found that the epididymal sperm plasma membrane contained a trypsin-like proteinase which inactivated adenylate cyclase. Bicarbonate activates adenylate cyclase as reported previously, but, at the same time, the anions enhance the inactivation of the enzyme by the membrane-bound trypsin-like proteinase. This phenomenon is not due to the direct activation of the proteinase, but closely related to the activation of adenylate cyclase by bicarbonate. It was also found that seminal proteinase inhibitors blocked the inactivation of adenylate cyclase and maintained the bicarbonate activation of the enzyme at high level. Actually, bicarbonate keeps adenylate cyclase fully active in ejaculated sperm, because membrane-bound proteinase is completely inhibited by the seminal proteinase inhibitors. These results suggest that the interactions between membrane-bound proteinase and seminal proteinase inhibitor are involved in the regulation of the bicarbonate-sensitive adenylate cyclase system.

[Effective hormone therapy of prostatic cancer with lung metastasis: 2 cases].

Many prostatic cancer patients have local symptoms such as dysuria and hematuria, but relatively few are seen with lung metastasis. This time we experienced 2 cases of prostatic cancer with a lung metastasis focus as the first symptom. Administration of diethylstilbestrol 500 mg/day for 20 days produced marked effects; reduction or disappearance of the lung metastasis focus, noticeable reduction of prostatic tumor and the improvement of their total condition. The literature is also reviewed.

Activation of boar proacrosin is effected by processing at both N- and C-terminal portions of the zymogen molecule.

A mixture of 55 and 53 kDa boar proacrosins was autoactivated at pH 8.5 to produce a 43 kDa intermediate form and a 35 kDa mature acrosin, and each of four forms of (pro)acrosins was isolated. Analysis of the N-terminal sequences of the two proacrosins indicated the existence of a segment corresponding to the acrosin light chain at the N-terminal end of the zymogen. Two N-terminal sequences identical with those of the light and heavy chains were found in the intermediate form and mature acrosin. The proacrosins and the intermediate contained many more proline residues than the mature enzyme. These results indicate that the activation of boar acrosin zymogen is achieved by the removal of a C-terminal segment rich in proline residues and by the cleavage of the Arg23-Val24 bond leading to the formation of the light and heavy chains.

[Malignant fibrous histiocytoma of the scrotal wall--a case report].

The case involves a 64-year-old male who was found to have a gradually enlarging tumor which was responsible for a slight tenderness in his scrotum for a month. Tumor excision was performed, and the tumor size was found to be 3 X 2 X 2 cm. A histologic examination of this tumor revealed a malignant fibrous histiocytoma of the scrotal wall. The patient received UFT chemotherapy. Five months after the excision, the patient was rehospitalized with a local recurrence in the scrotum. After a second operation, the patient was treated with radiotherapy.

[Bladder carcinoma associated with hypercalcemia: report of 3 cases].

Three cases of bladder carcinomas associated with hypercalcemia were presented. Case 1: A 43-year-old male was diagnosed as having bladder carcinoma 2 years ago and treated in another hospital by partial cystectomy with uretero-vesiconeostomy of the left side. On March 6, 1985, in our clinic, he received a total cystectomy with an ileal conduit for urinary bladder carcinoma. A 5-month post-operative clinical examination showed recurrence of the carcinoma with elevated serum Ca level (15.6 mg/dl). He was treated with eel-calcitonin, predonine, indomethacin, and furosemide, but died on August 23, 1985. Autopsy disclosed carcinoma of the urinary bladder (transitional cell cancer much greater than squamous cell cancer). Case 2: A 51-year-old male was diagnosed as having transitional carcinoma of the urinary bladder and was treated in our clinic by total cystectomy with cutaneous ureterostomy. Three months after the operation, he was readmitted with complaints of anorexia and disturbances of consciousness. His serum Ca level was elevated (17 mg/dl), and clinical examination showed recurrence of the carcinoma; bone scan revealed no metastasis. He was treated by radiotherapy with eel-calcitonin, predonine, indomethacin, and furosemide, but died on October 22, 1985. Autopsy disclosed carcinoma of the urinary bladder (squamous cell cancer). Case 3: A 72-year-old male was diagnosed as having a large urinary bladder tumor. An IVP showed a left non-functioning kidney. On admission, he complained of anorexia and confusion. His serum Ca level was elevated (13.8 mg/dl); bone scan revealed no metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical effects of allylestrenol on benign prostatic hypertrophy by double-blind method].

A double blind comparative clinical trial was performed with allylestrenol (AE) and chlormadinone acetate (CMA) to investigate the clinical efficacy of AE on prostatic hypertrophy. Both drugs were administered orally for 12-16 weeks in a daily dose of 50 mg. With both drugs marked improvement of disorders of micturition and a slight decrease in the size of the hypertrophied prostatic node were observed. No significant difference was observed between the two drugs in the overall efficacy of the treatments. Significant improvement of practically all parameters used for evaluation of results was observed with both drugs following treatment. Ultrasonotomographic examination revealed diminution of the size of the prostatic node and x-ray examination of the ureter showed improvement in elevation of the fundus of the bladder. These improvements were better after CMA treatment than after AE treatment. With all other parameters used no significant difference was observed between the two drugs. Mild adverse effects such as loss of sexual desire and potency were observed in a few cases. The incidence of side-effects was lower following AE treatment, and the incidence of loss of sexual desire and potency was significantly lower after AE than after CMA. Taking into consideration efficacy and safety of the treatments, no significant difference was observed in usefulness between the two drugs, and we were able to confirm the usefulness of AE for the conservative treatment of prostatic hypertrophy.

[Assessment of prostatic weight by means of computed tomography and urethroscopy].

Preoperative determination of prostatic weight in patients with prostatic hyperplasia is important in determining the choice of the surgical technique used. Prostatic volume determination with CT scans, using the ellipsoid formula, appears to be quite accurate. CT scanning of the prostate gland was performed in 34 patients with prostatic hyperplasia (2 cases with cancer). All scans were performed with a Toshiba TCT-60A-30 scanner, and were made for 10 mm slices as follows. From the CT image the maximum transverse diameter (a) sagittal diameter (b), and the maximum transverse area (S) were easily determined. The long axis was calculated from the bladder neck to the distal edge of the vermontanum by urethroscopy (Fig.1). A rough calculation was given by formula V1 or V2. V1 = pi abc/6 or V2 = 2/3 Sc. Calculated volumes of the prostate were compared with the weight of surgical specimens (TUR-P 27 cases, open surgery 7 cases). A good correlation was obtained by this method, i.e., regression equation V1: y = 1.21x + 9.68 (gamma = 0.9376); V2: y = 1.31x + 10.58 (gamma = 0.9471). This method is considered valuable for preoperative measurement of prostatic size, and is useful when evaluating changes in prostatic volume during non-surgical treatment.

[Clinical and pathological study of renal pelvic and ureteral tumors].

This report is on 25 patients with primary urothelial tumor in the upper urinary tract who were admitted to our hospital from February, 1969 through January, 1983. The patients were 18 males and 7 females with a mean age of 66 years. The affected side was the right side in 11 cases, the left side in 12 and bilateral in 1 case (bilateral asynchronous ureteral tumor). The major symptoms were hematuria (69%) and flank pain (25%), with rare signs of fever. Total nephroureterectomy with bladder cuff was employed as the surgical method in 19 out of 25 cases. We performed conservative surgery in the case of non-infiltrating bilateral ureteral tumor. Pathologically, all 25 patients had transitional cell carcinoma. Over-all survival rate at 3 and 5 years was 64% and 51%, respectively. Our findings coincided with earlier reports by others that the prognosis of primary tumors in the upper urinary tract is related to the grade and stage of the tumor.