Effect of long-term administration of finasteride (MK-906), an inhibitor of 5 alpha-reductase, in patients with benign prostatic hyperplasia.

We evaluated the effect of long-term administration of finasteride (MK-906), a potent inhibitor of 5 alpha-reductase in patients with benign prostatic hyperplasia (BPH). The effect of an increase in dose was also assessed. Finasteride was administered to 61 patients with BPH at the dose of 1 mg/day for 48 weeks. Thirty three of these patients subsequently received finasteride at the dose of 5 mg/day for further 24 weeks in an open extension study. Urinary symptoms, urinary flow rate, residual urinary volume, prostatic volume and serum concentrations of dihydrotestosterone and prostate-specific antigen were examined periodically during the treatment. The size of the prostate and total urinary symptom scores decreased progressively during the first 16 weeks of treatment. The patients who received finasteride had a significant increase in the maximal urinary flow rate and a significant decrease in residual urinary volume. After 72 weeks of treatment, finasteride at an increased dose of 5 mg did not provide additional benefit to patients, although the effects of the drug at a dose of 1 mg were well maintained. Treatment with finasteride was well tolerated at both doses. In conclusion, the treatment of BPH with 1 mg of finasteride per day for 48 weeks results in a significant increase in maximal urinary flow rate, and a decrease in prostatic volume, symptoms of obstruction and residual urinary volume, with minimal toxicity.

[Chyluria treated with inguinal lymphangiovenous and lymph node-venous anastomosis: a case report].

Stripping and ligation of the renal lymphatics has been a standard operation for patients with chyluria in Japan. However, recently, inguinal lymph node-saphenous vein anastomosis and lymphangiovenous anastomosis in the spermatic cord or the lower limb are introduced as a microsurgical treatment of chyluria with good result from China. We present a case of 50-year-old female with chyluria, which was cured by the lymphatic-venous anastomosis at the groin. The patient had lived in Okinawa, an area of endemic filariasis, till 23 years of age. She noted chyluria for the first time at 28 years of age, when it was treated by irrigation of the renal pelvis with silver nitrate solution. The symptom recurred at 48 years of age, and fatigue developed two months before admission. The conservative treatments including rest, low fat diet and repeated irrigation of the renal pelvis were carried out, but these were ineffective. Therefore, bilateral inguinal lymph node-saphenous vein anastomosis and lymphangiovenous anastomosis in the same wound on the right were performed. The chyluria disappeared five months after the operation. The lymphatic-venous anastomosis at the superficial part of the body may be the surgical procedure of choice, because they are effective, simple, less invasive and less traumatic.

Sodium pump distribution is not reversed in the DBA/2FG-pcy, polycystic kidney disease model mouse.

Recently, it has been reported that Na,K-ATPase in the renal epithelia of human autosomal dominant polycystic kidney disease and cpk mouse, a murine model of autosomal recessive polycystic kidney disease, mislocates to apical plasma membrane and that mislocated Na,K-ATPase causes the cyst formation. Whether the DBA/2FG-pcy mice, which are presumably a suitable model for autosomal dominant polycystic kidney disease, also exhibit the reversal polarity of Na,K-ATPase localization was examined. Kidneys of newborn DBA/2FG-pcy mice, and those at early and late stages of cyst development were examined by immunohistochemical techniques. At any stage, abnormal distribution of Na,K-ATPase on the apical membranes of tubular epithelial cells could not be detected. It is suggested that cysts can be formed without reversed polarity of Na,K-ATPase distribution in pcy mice.

[Duplication of the inferior vena cava with left renal cell carcinoma].

A case of duplication of the inferior vena cava (IVC) with left renal cell carcinoma is presented, and the clinical and radiological significance is discussed. Although computed tomographic (CT) scanning, inferior venacavography and renal venography revealed a sufficient amount of anatomical information, an accidental rupture to the inferior vena cava occurred during the procedure. The patient subsequently required 7 units of blood, and suffered acute hepatitis two months following the blood transfusion. However, no recurrences of renal cell carcinoma and hepatitis have been observed four year after the procedure.

Inhibition of murine AIDS (MAIDS), development by the transplantation of bone marrow cells carrying the Fv-4 resistance gene to MAIDS virus-infected mice.

To examine whether the resistance allele of the Fv-4 gene (the Fv-4r gene) is a dominant inhibitory-product-encoding gene which an be used to prevent the development of murine AIDS (MAIDS), bone marrow cells from BALB/c-Fv-4wr mice were transplanted into BALB/c mice and C57BL/6 mice infected with MAIDS virus. Almost all of the virus-infected BALB/c and C57BL/6 mice developed MAIDS within 4 months and died 2 or 3 months later. However, when the virus-infected mice were subjected to cobalt irradiation and then given an intravenous injection of 10(7) BALB/c-Fv-4wr mouse bone marrow cells, the recipient mice survived much longer than the untreated mice, which suggests that the Fv-4 gene is a dominant inhibitory gene that is potentially useful in gene therapy of MAIDS.

The augmented rectal bladder for urinary diversion: experience with the original valved rectum and a valve-less modification.

Kock's augmented and valved rectum was created in 10 patients following total cystectomy. During an observation period of up to 46 months, 4 patients died (1 from a recurrence of cancer, 1 from multiple organ failure subsequent to diabetes mellitus, 1 from coronary insufficiency, and 1 from cerebral hemorrhage). Post-operative complications included valve failure in 1, hydronephrosis in 2, and mild nocturnal urinary incontinence in another. Hyperchloremic metabolic acidosis was particularly notable in the cases without an intussuceptive valve of the rectum. Their base excess ranged from -6.9 to -15.0 mM/l but the condition was satisfactorily controlled by oral administration of alkaline agents. Although the present method has a number of shortcomings, the absence of a stoma and elimination of the need for self-catheterization are outstanding benefits. For these reasons, we believe that it is an effective option for urinary diversion.

[A case of retroperitoneal schwannoma associated with primary hyperparathyroidism].

A rare case of benign retroperitoneal schwannoma in a 47-year-old female is reported. She was initially diagnosed to have an adrenal tumor at the Prefectural Cancer Center Hospital and was subsequently admitted to this hospital. When she was admitted, she was diagnosed as undergoing a hypercalcemic crisis (s-Ca 9.2mEq/l). Serum intact-PTH was elevated, but urine cyclic-AMP and % TRP were almost normal. Gd-DTPA enhanced T1 weighted MRI showed a hyperintensity area between the trachea and the thyroid. A parathyroid tumor and a retroperitoneal tumor were excised completely. The final pathological diagnoses were determined to be a parathyroidal adenoma and a retroperitoneal Schwannoma. After a 6-month follow-up period no recurrence and no electrolytic imbalance were detected and the patient presently displays no further symptoms.

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis.

Ureterolysis and subsequent intraperitonealization were performed laparoscopically in 2 patients with unilateral idiopathic retroperitoneal fibrosis. The operative procedure was easily accomplished, and the outcome was excellent in the patient who had a ureteral stricture of 2 cm in length, whereas the operation was technically more complicated with a prolonged operation time in the other patient who had a stricture more than 5 cm in length. The convalescence period after the operation was short in both cases. Laparoscopic ureterolysis is a less invasive alternative to conventional open surgery, particularly in patients with involvement of a unilateral ureter of short length.

Microsurgical epididymovasostomy for obstructive azoospermia: factors affecting postoperative fertility.

Azoospermia due to epididymal obstruction can be treated by microsurgical epididymovasostomy with high patency rates. Twenty-four azoospermic patients with epididymal obstruction due to a variety of causes underwent 26 microsurgical epididymovasostomies. The overall patency rate following surgery was 80.8% and impregnation was achieved by 10 patients (41.7%). Factors affecting the postoperative impregnation rate were etiology and duration of obstruction. Patients with an obstruction for < or = 15 years, caused by epididymitis or post-vasectomy epididymal blow-out, achieved a higher impregnation rate than the others (8 of 9 vs. 2 of 11, p = 0.0019). The motility of epididymal sperm or the presence of serum antisperm antibodies had no apparent effect on postoperative fertility. Microsurgical epididymovasostomy is particularly effective in patients with epididymitis or vasectomy patients with a short-term obstruction.

[A case of cholesterol granuloma with hematoma of tunica albuginea].

A case of cholesterol granuloma with hematoma of the tunica albuginea is reported. A 52-year-old man complained of a painless mass in the left scrotum. The mass was 50 x 25 x 30 mm in size. An operation was performed. Macroscopically the mass originated from the tunica albuginea and was a cystic lesion with a thick fibrous capsule. The cystic lesion was filled with an old hematoma. An extirpation was performed. Microscopically, the sections showed fibrogranulomatous tissue containing innumerable cholesterol clefts and numerous foreign body giant cells. The histological diagnosis was cholesterol granuloma with hematoma. This is the sixth case of cholesterol granuloma of the external genitalia, and is the first case of cholesterol granuloma with hematoma of the tunica albuginea in the literature.

Platelet-activating factor (PAF) in male reproductive organs of guinea pigs and rats: effect of androgen on PAF in seminal vesicles.

Studies were conducted on platelet-activating factor (PAF) in male reproductive organs. Total lipids were extracted from the seminal vesicles, and PAF was purified by silicic column chromatography, thin-layer chromatography, and HPLC. PAF activities in the seminal vesicles of guinea pigs and rats as measured by assay of platelet aggregation were 0.26 and 0.25 ng PAF/mumol original phospholipids. These activities were inhibited by the specific PAF antagonists CV6209 and L652,731. In guinea pigs, PAF activity decreased to 50% and 31% of the normal level 2 wk and 4 wk, respectively, after castration. The activity increased to 136% of the normal level on administration of 1 mg of testosterone propionate every day for 1 wk beginning 2 wk after castration, but decreased to 74% of the control level on administration of vehicle. Furthermore, administration of 100 IU of hCG every other day to guinea pigs resulted in increased activity, to 132% (p < 0.05) and 154% (p < 0.01) of the activity in vehicle-treated animals on Days 1 and 3, respectively. Electron microscopic studies showed changes in the rough endoplasmic reticulum of the epithelial cells of the seminal vesicles in castrated guinea pigs. (The rough endoplasmic reticulum is involved in PAF biosynthesis.) PAF activity was also demonstrated in tissues of the testis, epididymis, and vas deferens of guinea pigs and rats, and in the prostate of rats. Thus PAF may play important physiological roles in male reproductive organs.

[A case of retrocaval ureter treated in childhood].

A case of retrocaval ureter in a 10-year-old boy is reported. His chief complaint was asymptomatic total macrohematuria. Physical examination and all laboratory findings were within normal limits, but drip infusion pyelography revealed a right hydronephrosis with "S shaped" ureter. The diagnosis was confirmed by enhanced CT scan. After follow-up for 1 year and a half, right uretero -ureterostomy was performed because the severity of the hydronephrosis had increased. We review 25 cases of retrocaval ureter in childhood reported in the Japanese literature and compare the clinical characteristics between infant cases and adult cases.

[Traumatic dislocation of the testis].

Dislocation of the testis is a rare injury, with only 73 cases having been reported in Japan. We herein add 6 cases. Lately, accidents involving teenage patients, primarily involving motorcycles, have been increasing. Closed reduction is recommended, but it was successful only 5 of 73 cases. The results of testicular biopsies suggest that early surgical management is required when closed reduction is unsuccessful.

[A case of renal vein thrombosis].

A case of renal vein thrombosis in a seventy-five year old female was reported. She complained of severe left flank pain. The symptoms and signs resembled obstruction from a ureteral calculus. The kidney-ureter-bladder X-ray showed a calcification in the pelvic cavity. She was admitted under the initial diagnosis of left ureteral stone. The venous phase of renal arteriography revealed venous collaterals (ureteric vein and gonadal vein). Selective renal phlebography demonstrated a radiolucent area. Warfarin, 6 mg orally daily, has been administered for a year. It has effectively prevented subsequent emboli. This was a rare case of renal vein thrombosis in an old patient, because it was not associated with nephrotic syndrome or thromboembolic state and because it presented as sudden onset.

[Experience with laparoscopic nephrectomy].

Laparoscopic procedures are promising techniques which allow less invasive surgery not only for intra-abdominal organs but also for retroperitoneal organs. Laparoscopic nephrectomy was first described by Clayman et al. We removed the left kidney of a 36-year-old male patient using laparoscopic procedures according to Clayman's technique. The kidney had developed hydronephrosis due to congenital ureteropelvic junction stenosis. In the peritoneal cavity the freed kidney was pushed into a Lapsac, minced using scissors and forceps, and removed without elongation of the wound. During the operation, pneumoperitoneum with CO2 gas induced increases in PaCO2, central venous pressure, pulmonary artery wedge pressure and cardiac output, all of which the patient tolerated well. The patient was discharged from the hospital on the 9th postoperative day. Laparoscopic nephrectomy is a useful alternative to the conventional open surgery in selected cases, when surgical techniques and instruments are improved appropriately.

[Yolk sac tumor of the testis in children: report of two cases].

Two cases of yolk sac tumor of the testis are presented. The patients were 17 months and 24 months old. The children were inflicted with painless swelling of their left scrotal content. alpha-Fetoprotein levels were elevated at presentation but decreased within normal limits after orchiectomy. Chest X-rays and CT scans were negative. The cases were diagnosed as stage I. Fifty six cases of testicular yolk sac tumor in children have been reported in Japan since 1981. There were no recurrent stage I cases. One patient with stage II and 3 patients with stage III died despite chemotherapy, while three children with stage II or stage III disease survived more than 36 months after a positive response to chemotherapy. We conclude that prepubertal stage I yolk sac tumor is treated best initially by orchiectomy alone. Aggressive chemotherapy has a major role in salvage of stage II or stage III patients.

Keratin profiles in normal/hyperplastic prostates and prostate carcinoma.

Immunoreactivities in 25 cases of prostatic adenocarcinoma and 10 normal/hyperplastic prostates were investigated in methacarn-fixed, paraffin-embedded serial sections using a panel of nine anti-keratin monoclonal antibodies (mAbs); 34 beta E12, CK8.12, 312C8-1, CK4.62, RPN1165, RPN1162, 35 beta H11, CK5, M20, and one of anti-actin mAb, HHF35. In normal/hyperplastic prostates, RPN1162, 35 beta H11, CK5 and M20 stained luminal cells without staining basal cells, and 34 beta E12, CK8.12 and 312C8-1 stained basal cells but not luminal cells. Other mAbs, CK4.62 and RPN1165, stained basal cells as well as luminal cells. All of the mAbs labelling luminal cells stained cancer cells with variable frequencies in a manner unrelated to the grade of tumour differentiation. Of the prostate cancer cases 92% were scored positive with M20, 84% with 35 beta H11, 80% with CK5, 68% with CK4.62, 60% with RPN1165 and 4% with RPN1162. However, basal cell-specific keratins labelled with 34 beta E12, CK8.12 and 312C8-1 were totally negative in the cancer cells. HHF35 showed no labelling in normal, hyperplastic or neoplastic epithelial cells of the prostate. Our findings indicate that the major part of the cells of prostatic adenocarcinomas have keratin phenotypes similar to luminal cells but not basal cells, and that no myoepithelial differentiation can be detected in epithelial cell of the prostate. Thus, mAbs for keratins facilitate the identification of epithelial cell phenotypes in normal, benign and malignant conditions of the prostate.

[Two cases of 2.8-dihydroxyadenine stone with a partial deficiency of adenine phosphoribosyltransferase].

We report two cases of 2.8-dihydroxyadenine stones due to partial deficiency of adenine phosphoribosyltransferase. The first patient is a 41-year-old female. Radiologic examination revealed left radiolucent renal stones and contracted kidney. Left nephrectomy was performed. Infrared spectrometric analysis of the stones revealed 2.8-dihydroxyadenine calculi. The adenine phosphoribosyltransferase activity in lymphocyte (T cell) was 19.5% of the control level. After the operation, the patient was given 300 mg/day of alloprinol. There have been no signs of recurrence. The second patient was a 52-year-old male. Radiologic examination revealed radiolucent stones of the right kidney and the urine bladder. Percutaneous nephrolithotomy and cystolithotripsy were performed. Infrared spectrometric analysis of the stones revealed 2.8-dihydroxyadenine calculi. The adenine phosphoribosyltransferase activity in the lymphocytes (T cell) was 21% of the control level. After the operation the patient was given 200 mg/day of alloprinol and put on a low purine diet. There have been no signs of recurrence.

[A case of uretero-vaginal fistula with ureteral foreign body stone originated from the suture thread].

A 32-year-old female was admitted to our hospital with the chief complaint of vaginal discharge of urine. She had undergone radical hysterectomy due to uterine cancer at another hospital by a gynecologic surgeon 5 years earlier. X-ray examination showed a stone-like shadow at the left ureter without hydronephrosis. She was diagnosed with ureterovaginal fistula with the left ureteral stone. Left ureterolithotomy and ureterovesiconeostomy was performed. The stone revealed a foreign body stone originating from the silk worm-gut which had penetrated accidentally the ureter when the vaginal wall was sutured at the previous surgery. Including our case, 15 cases of foreign body stones in the upper urinary tract were found in the Japanese literature and none of them were associated with ureterovaginal fistula.

[A case of emphysematous cystitis with familial amyloidosis].

This is a report of the thirteenth known case in Japan of emphysematous cystitis. A 70-year-old man visited our hospital because of pollakisuria and macrohematuria on November 21, 1989. The patient had been known to have familiar amyloid polyneuropathy for the previous 3 years. Urinalysis showed marked hematopyuria. The residual urine was 216 cc, and urine cultures yielded 10,000,000 colonies of Escherichia coli per ml. Laboratory studies revealed systemic inflammatory findings, but no diabetic change. A plain X-ray film of the abdomen and an excretory urogram (DIP) showed small linear and round gas collections in the bladder shadow. A CT scan revealed multiple gas locules within the bladder wall. A diagnosis of emphysematous cystitis was established. The patient was given antibiotics, and there was striking clinical improvement. Histological examination of the endoscopically obtained biopsy specimen of the bladder revealed amyloidosis. We believe that this patient had a cystitis emphysematosa precipitated neurogenic bladder due to amyloid polyneuropathy and amyloidosis of the bladder.