Pathogenicity of the pinewood nematode, Bursaphelenchus xylophilus, to Japanese larch, Larix kaempferi, seedlings.

Pathogenicity of the pine wood nematode, Bursaphelenchus xylophilus, to Japanese larch, Larix kaempferi, seedlings was tested with inoculation experiments under nursery conditions. Water suspensions of nematodes (mixed stages cultured on Botrytis cinerea or dispersal fourth-stage juveniles (DJ4) extracted from the adult Japanese pine sawyer, Monochamus alternatus) were injected into the stems of 2- and 3-year-old Japanese larch and Japanese black pine, Pinus thunbergii, seedlings growing in a nursery. In another treatment, Japanese pine sawyer adults holding DJ4 were released under a net that covered the upper half of the seedlings. Regardless of nematode inoculation method, Japanese larch seedlings were as susceptible as Japanese black pine seedlings to B. xylophilus under nursery conditions. The rate of disease development was similar on larch and pine seedlings. Nematode population densities were lower in the stems of dead larch seedlings than in the stems of dead pine seedlings. Histopathological observations revealed that the distribution of nematodes in the stems of dead larch seedlings was mostly limited to the cortex, phloem and cambial zone. Traumatic resin canal formation was one of the most characteristic symptoms in larch seedlings which was dissimilar to that in pine seedlings.

[Analysis of clinical costs for inpatients with the urologic diseases in 1997].

OBJECTIVES: Because of recent increases in health care costs, reformation care cost system similar to the disease related group/prospective payment system (DRG/PPS) was attracted attention in Japan. We analyzed the costs for inpatients with urologic diseases in our institution and compared them with the costs reported in Japanese trials of DRG/PPS. MATERIALS & METHODS: Subject consisted of 363 consecutive urologic diseases inpatients treated in our hospital in the period between April 1 1997 and March 31 1998. Of these 107 had bladder tumor, 79 BPH (benign prostatic hyperplasia), 34 prostate tumor, 32 renal tumor, 17 in urinary stone (excluding cases with bladder stones) and 94 cases in others. The total hospital charge for each case was calculated, and the averages and standard deviations for each disease were analyzed. We analyzed the relationship between hospital charges for each disease, and complications, the degree of disease, age and length of stay (LOS). Health care costs are assessed in unit, each of which is the equivalent of 10 yen. RESULTS: The average of total hospital charges was 108,841.6 points for bladder tumor, 61,692.2 points for BPH, 96,825.3 points for prostate tumor, 188,459.0 points for renal tumor, and 66,052.2 points for urinary stones. The standard deviation was 99,611.3 points for bladder tumors, 16,712.9 points for BPH, 65,419.3 points for prostate tumor, 204,389.6 points for renal tumor and 30,081.7 points for urinary stone. There was a positive correlation between hospital charge and LOS in most diseases. The average hospital charges for each disease were much higher than the reimbursement charges of the trial Japanese DRG/PPS. DISCUSSION: Shortening of LOS using established clinical pathways reduces health care costs. However, in Japan, the wide range of preliminary results suggests that it may be too early to introduce the DRG/PPS system for health care cost. Furthermore nationwide investigations are needed before the introduction of the DRG/PPS system into Japanese health care reimbursement system.

[Histopathological effect and its predictors of neoadjuvant hormonal therapy by combined androgen blockade].

OBJECTIVES: Combined androgen blockade (CAB) uning LH-RH agonist and flutamide has been performed as neoadjuvant therapy for T 2, 3 prostate cancers (CaP). The histological effects of neoadjuvant CAB therapy and influential factors were investigated. METHODS: Materials were 20 CaP cases which were underwent radical prostatectomy (RP) after neoadjuvant CAB therapy. All cases were diagnosed by echo-guided sextant needle biopsies. RP was performed after serum PSA was decreased to undetectable level. Histological effect was evaluated by general rule for clinical and pathological studies on prostate cancer (Japanese Urological Association). All cases were divided 2 groups by histological effects as follows: Group A (poor effect group): G 0 and G 1, Group B (good effect group): G 2 and G 3. Immunostaining of p 53 (mutant type), bcl-2 and Chromogranin A (ChA) were performed for both pretreatment needle biopsy and RP specimen. In addition, pretreatment serum PSA and Gleason grade were also investigated. RESULTS: Down grading were found in 30%. Down staging were found in 35% (7 cases). All 7 cases were negative surgical margins and 5 of 7 were clinical T 3. Negative bcl-2 of biopsy specimen was correlation with down grading (p = 0.008). In the histopathological evaluation, G 0 was 1, G 1 were 10, G 2 were 6 and G 3 were 3 cases. Gleason 4 or 5 elements of biopsy were found in 9/11 cases in Group A but only 3/9 cases in Group B (p = 0.027). The bcl-2 positive cells of biopsy were found in 8/11 cases in Group A but only 1/9 cases in Group B (p = 0.006). The p 53 and/or bcl-2 positive cells of biopsy were found in 10/11 cases in Group A but only 3/9 cases in Group B (p = 0.007). Serum PSA and ChA were not correlation with histological effect of neoadjuvant CAB therapy. But, in 3 cases, ChA positive cell appeared after neoadjuvant therapy. CONCLUSIONS: We could not expect more than 50% cases to show the down grading and down staging. But, in T 3 case, surgical failure could be decrease. We could expect prostate cancer cases without positive bcl-2 cells, p 53 over expression and Gleason 4 x 5 to reveal the good histological effects of neoadjuvant CAB therapy.

Efficacy of transurethral needle ablation of the prostate for the treatment of benign prostatic hyperplasia.

BACKGROUND: We evaluated the efficacy and safety of transurethral needle ablation (TUNA) of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH) as one institute participating in a Japanese clinical trial. METHODS: Thirty-three patients with symptomatic BPH were treated with the TUNA procedure in our institute. The international prostate symptom score (IPSS), quality of life (QOL) score, residual urine volume (RV), prostate volume (PV) and peak urinary flow rates (Qmax) were measured and complications were assessed. RESULTS: We followed and evaluated 30 of the 33 cases. At 12 months there were significant improvements in the IPSS (20.7 to 11.2, P < 0.0001), QOL score (4.9 to 2.1, P < 0.0001), RV (46.6 to 22.6 mL, P < 0.01), PV (37.8 to 30.0 mL3, P < 0.002) and Qmax (8.00 to 11.0 mL/s, P < 0.002). There were no serious complications. CONCLUSION: This trial shows that the TUNA procedure is a safe and efficacious treatment for symptomatic BPH.

[Three cases of transitional cell carcinoma in bladder diverticulum treated by a bladder-preserving approach].

Three cases of transitional cell carcinoma (TCC) in the urinary bladder diverticulum were encountered during a period of 12 years and bladder preserving treatments were performed. Case 1: A 78-year-old man was admitted with a chief complaint of hematuria. Papillary tumors in the diverticulum of the right bladder wall were revealed (TCC, G3, T3N0M0). Intraarterial infusion chemotherapy was performed and complete remission was achieved. When a recurrent bladder tumor appeared 22 months later, transurethral resection was performed and there was no evidence of recurrence for 50 months. Case 2: A 60-year-old man was admitted with a chief complaint of gross hematuria. Cystoscopic examination revealed papillary tumors in a bladder diverticulum near the ureteral left orifice. Transurethral resection revealed TCC G2 and carcinoma in situ. Partial cystectomy, including the bladder diverticulum, and vesicoureteral neostomy was performed. The histological stage of the tumor was pTis and the wall of diverticulum possessed a thin muscle layer histopathologically. Twenty two months later, recurrence in the left bladder wall developed and transurethral resection and bladder instillation therapy were performed. For 21 months he had no evidence of recurrence. Case 3: A 59-year-old man was admitted with a chief complaint of hematuria. A solid tumor in the diverticulum of the bladder left wall was revealed. After 4 courses of intraarterial infusion chemotherapy, 41% remission was achieved and partial cystectomy was performed. Histopathological diagnosis was TCC G3, pT3b, INF-alpha, v (-), ly (-), and no muscle layer was found in the diverticulum. There was no evidence of recurrence 16 months after operation. By using the combination therapy, bladder preserving treatment is possible in the cases of bladder cancer arising in the diverticulum.

Effect of dual inhibition of 5-alpha-reductase and aromatase on spontaneously developed canine prostatic hypertrophy.

BACKGROUND: Our aim was to assess the effect of dual inhibition of 5-alpha-reductase and aromatase on prostate glands. METHODS: We investigated the morphological changes in the prostate gland and the changes in the hormonal environment after administration of finasteride and arimidex to intact canine specimens. The study consisted of four groups: a 5-alpha-reductase only group (5RI only, n = 5); a 5RI plus aromatase-inhibitor combination group (5RI + ARI combination, n = 5); a BPH control group (n = 3); and a castration control group (n = 3). Finasteride (1 mg/kg/day) and the same dose of arimidex were orally administered for 80 days. RESULTS: In the 5RI group, a significant decrease in the serum dihydrotestosterone (DHT) level was found, and prostatic volume was significantly decreased. However, significant increases in serum testosterone (T) and DHT levels were observed, with a concomitant increase in prostatic volume in the 5RI + ARI combination group. Morphometric analysis showed that histopathological findings in the 5RI + ARI combination group were similar to those in the BPH control group. CONCLUSIONS: Dual inhibition of 5-alpha-reductase and aromatase resulted in a significant increase in prostate volume, accompanied by a 3-10-fold increase in serum testosterone levels and a significant increase in testicular volume.

Effects of transjugular intrahepatic portosystemic shunt (TIPS) on esophageal motor function and gastroesophageal reflux.

The effects of transjugular intrahepatic portosystemic shunt (TIPS) placement on esophageal motor function and gastroesophageal reflux were investigated in patients with esophageal varices. In six men with esophageal varices, esophageal manometry and upper gastrointestinal endoscopy were performed before and 15-20 days after TIPS placement. Intraesophageal pH monitoring was performed in the four patients with severe esophageal varices (defined as the largest sized varices) following TIPS placement. Findings were compared with those in six healthy men (controls) who underwent esophageal manometry and intraesophageal pH monitoring. The esophageal varices resolved or were reduced after TIPS placement. Resting lower esophageal sphincter (LES) pressures were similar in the study group before and after TIPS placement and in the control subjects. The incidence and progression of esophageal contractions were similar in the study group before and after TIPS placement and in the control subjects. At 3 cm above the LES, the amplitude of esophageal contraction after TIPS placement was significantly higher than that before TIPS placement. At 3 and 8 cm above the LES, the amplitude of esophageal contraction in the control subjects was significantly higher than that in the study group before and after TIPS placement. Esophageal acid exposure time after TIPS placement was similar to that in the controls. TIPS placement is a useful treatment that improves esophageal motor function without the occurrence of pathologic gastroesophageal reflux.

[A case of metastasis to the seminal vesicle of renal cell carcinoma].

A case of metastasis to the seminal vesicle of renal cell carcinoma is reported. A 60-year-old man was referred to our department for evaluation of intermittent hematospermia and asymptomatic macrohematuria for about 2 years. He had a left radical nephrectomy for localized renal cell carcinoma 5 years ago. Panendscopy showed a little bleeding of posterior urethra, but there were no abnormal images of upper urinary tracts. Two years later he had asymptomatic macrohematuria again and panendscopy showed swelling and bleeding of verumontanum. Transurethral resection of verumontanum revealed clear cell carcinoma histopathologically and CT revealed seminal vesicle or prostate tumor, then total cystectomy was performed. Pathological examination indicated metastasis to siminal vesicle of renal cell ccarcinoma. There has been no report of metastasis to seminal vesicle of renal cell carcinoma in literature. This is the first case in the world.

[Transjugular intrahepatic portosystemic shunt for the treatment of refractory ascites].

Five cirrhotic patients with refractory ascites were treated with transjugular intrahepatic portosystemic shunt (TIPS). Before TIPS, although patients were received salt restriction (5 g/day), diuretic therapy (furosemide 112 mg/day, spironolactone 140 mg/day), albumin infusion and paracentesis, ascites did not show improvement. After TIPS, urine volume and urinary sodium excretion increased significantly. Mean body weight decreased significantly from 73 kg before TIPS to 63 kg a month after TIPS. Improvement of ascites after TIPS were associated with a significant reduction in the dose of diuretics. On discharge, complete resolution of ascites was found in 2 patients and mild ascites remained in 3 other patients. Four patients presented 6 episodes of shunt stenosis in the follow-up period, and were treated with balloon dilatation. Ascites increased on shunt dysfunction and showed improvement after balloon dilatation. Post-TIPS encephalopathy was seen in 2 patients and one of 2 was disabled. In conclusion, although post-TIPS shunt dysfunction and encephalopathy are common. TIPS is an effective therapy for refractory ascites in patients with cirrhosis.

Acute lymphoblastic leukemia with isolated adrenocorticotropic hormone deficiency.

A 57-year-old female was admitted to our hospital because of Philadelphia chromosome (Ph)-positive acute lymphoblastic leukemia (ALL). On admission, disturbance of consciousness and hyponatremia were recognized. The patient's endocrinological data showed low levels of adrenocorticotropic hormone (ACTH) (less than 5 pg/ml) and cortisol (5.9 microg/dl). Other anterior pituitary hormones were normal. Plasma ACTH and cortisol did not respond to the corticotropin releasing factor (CRF) test. A diagnosis of isolated ACTH deficiency was made. This is a rare case of isolated ACTH deficiency complicated with hematological malignancies.

Ovarian and hemolymph ecdysteroids in the terrestrial isopod Armadillidium vulgare (Malacostracan Crustacea).

Ovarian and hemolymph ecdysteroids in Armadillidium vulgare were analyzed at four stages of ovarian maturation through the reproductive molt cycle using high-performance liquid chromatography and radioimmunoassay. The major ecdysteroids in the ovaries and hemolymph of A. vulgare were 20-hydroxyecdysone and ecdysone in free and conjugated forms. The concentration of ovarian ecdysteroids reached a maximal level in maturing ovaries during stage D (premolt period) of the molt cycle. At the end of stage D, a high level of ecdysteroids was detected in fully matured ovaries. On the other hand, hemolymph ecdysteroid titers in reproductive females showed a peak during stage D and declined rapidly to a low level at the end of stage D. No appreciable differences in the amounts of hemolymph ecdysteroids and in molecular species of them were apparent in females in reproductive and nonreproductive molt cycles. The amounts of hemolymph ecdysteroids were about fivefold higher in females than those in males. These ecdysteroids may have a role in controlling ovarian development in female A. vulgare.

Invasive ductal carcinoma with a predominant intraductal component arising in a fibroadenoma of the breast.

A rare case of invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma of the breast in a 42 year old Japanese female was investigated by light microscopy. The patient, who had a well-defined, rubbery breast tumor measuring 2.0 x 3.0 cm, had undergone a tumorectomy 21 months after she noticed the tumor. Histologically, the fundamental architecture of the tumor showed an intracanalicular-type of fibroadenoma, but extensive proliferation of atypical cells was noticed in the lumen of the ducts. Tumor cells in the canaliculi had characteristics of ductal carcinoma, such as solid, comedo and cribriform patterns. As most of the ducts were occupied by carcinoma cells with several foci of microinvasion in the stroma of the fibroadenoma, it was diagnosed as invasive ductal carcinoma with a predominant intraductal component arising within a fibroadenoma. This coexistence of in situ proliferation and invasive lesions of carcinoma within a fibroadenoma suggest the origin of the carcinoma to have been in the epithelial component of the fibroadenoma. In addition, this study clarifies the fact that carcinoma cells may proliferate and spread along the lumen of pre-existing ducts of the fibroadenoma and speculates that the duct system of the fibroadenoma has complete continuity.

[Outpatient ESWL in 500 kidneys].

Between March 1989 and January 1992, 600 cases (636 kidneys) with upper urinary tract stones were treated with ESWL, using a Lithostar. Of these, 78.6% were carried out in our outpatient service, and in the last two years approximately 90% of cases have been treated as outpatient. We evaluated first 500 kidneys, treated with ESWL as outpatient. There were 481 cases involving 500 kidneys (19 bilateral cases). The ages of the 367 men and 114 women ranged from 16 to 77 years. There were 227 kidney stones and 273 ureter stones. Most of the stones were less than 20 mm. The average number of sessions and shock waves for each patient were 1.4 times and 6,988 waves, respectively. While 74% of the patients could be treated in only one session, 9% of them needed 3 sessions or more. Auxiliary measures were needed in 23 cases (D-J stent insertion in 5 cases and ureteral catheterization in 18 cases) and 474 cases (94.8%) were treated by in-situ procedures. At 3 months after treatment, 470 cases were evaluated and the stone-free rates of kidney stones and ureter stones were 70.3% and 84.5%, respectively with an overall stone-free rate of 78.1%. With regard to complications, the rate of the clinic visit because of pain after treatment was observed in 4.6% and higher than 38 degrees C in 2.5%. However, no serious perioperative complications occurred. From these results, outpatient ESWL was considered to be safe and efficient without serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)

[The influence of the sympathetic nervous system on brown adipose tissue: an experimental and histopathologic study on aging].

Brown adipose tissue (BAT) is known to be a principal energy source of non-shivering thermogenesis and related diet-induced thermogenesis. These regulate body temperature and body weight and are controlled by the dissipation of excessive dietary caloric intake. We carried out histopathologic, immunohistochemical and biochemical studies of BAT in rats in relation to aging changes. Four groups of Donryu strain male rats (5 each of 1 month, 2 months, 4 months and 20 months of age) were used. They had been given commercial chow and tap water ad libitum and were kept in an air-conditioned room. Body weight (BW), interscapular BAT weight (IBATW) and g IBATW/g BW of rats were measured. Nor-adrenalin (NA), and dopamine-beta-hydroxylase (DBH) of IBAT were determined. To evaluate the catecholaminergic effects of BAT, morphometric quantitation of BAT was carried out based on the cytoplasmic locularity of fat globules in the BAT cells. Distribution of DBH in BAT was assessed immunohistochemically by the avidin biotin peroxidase complex method. With the use of statistical analysis of variance procedure, there were highly significant decreases in the ratio of g IBATW/g BW (p less than 0.0001) and in the concentrations of NA (p less than 0.0001) and DBH (p less than 0.01) between young (weaning at 1 month old) rats and adult (aged from 4 to 20 months) rats. In the morphometric measurement, by the statistical analysis system (SAS) Spearman correlation coefficient method, there was a significant increase of Type 5 cell (monocular brown adipose tissue cell) in 4 month and 20 month rats, compared to 1 month and 2 month rats (p less than 0.05). Immunohistochemical study of BAT showed localization of DBH in perivascular mesenchymal cells which corresponded with the morphologic distribution of catecholamine as reported by Lever. The results suggest that in the processes of aging in the rat there are reductions in the ratio of g IBATW/g BW, NA and the activity in DBH.

[Treatment of asynchronous bilateral renal cell carcinoma. On our experience of enucleation for two cases].

In patients with either bilateral renal malignancies or with carcinoma occurring in a solitary kidney, the principle of en bloc removal of the tumor-bearing kidney cannot be applied. Recently we have performed surgical enucleation in two cases of asynchronous bilateral renal cell carcinoma. Case 1. A 60-year-old woman was hospitalized with diagnosis of left renal tumor 10 years tumor 10 years after right nephrectomy for renal cell carcinoma. The tumor was enucleated while occluding the renal vessels. Pathological examination revealed that the tumor (a nodule of 35 g) was renal cell carcinoma of grade I and perfectly covered by pseudocapsule. Hemodialysis was not required. The patient has been well for more than 11 months postoperatively and Ccr is 65 ml/min. Case 2. A 62-year-old man with slight elevation of serum GOT and GPT level was examined by CT, which revealed a space occupying lesion in the left kidney. He had undergone nephrectomy for renal cell carcinoma of right kidney 11 years ago. Three nodules of 56 g, 6 g and 3 g were removed by in situ enucleation. They were renal cell carcinoma of grade II and there was no malignant penetration of the pseudocapsule pathologically. After surgery hemodialysis was required 10 times for 21 days. Renal function has been refined gradually and the patient is well with 47.3 ml/min of Ccr at 4 months postoperatively. Before this report of 2 cases there were 22 cases of asynchronous bilateral renal cell carcinoma in Japanese literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Parathyroid hormone-related protein and transforming growth factor activities in an extract from a breast cancer associated with humoral hypercalcemia of malignancy.

The pathogeneses of hypercalcemia and hypophosphatemia which developed in a patient with metastatic invasive ductal breast carcinoma were studied. The patient had low plasma levels of immunoreactive parathyroid hormone (PTH) and 1,25(OH)2D, increased nephrogenous cyclic adenosine monophosphate (cAMP) excretion and low TmPO4/GFR, suggesting the presence of humoral PTH-like activity. The tumor extract showed activities which would stimulate bone resorption in vitro and cAMP generation in the osteogenic cell line, MC3T3 E1, and in the rat kidney cortex. In addition, the extract stimulated epidermal growth factor (EGF)-independent colony formation of the NRK 49F cells in soft agar, and inhibited the binding of EGF to A431 cells, indicating it to have transforming growth factor (TGF)-alpha activity. The extract contained appreciable amounts of immunoreactive PTH-related protein (PTH-rP) but negligible amounts of immunoreactive PTH. Thus, the PTH-like activity for stimulating cAMP generation in the bone and kidney was attributed to PTH-rP. Chromatographic analyses on reverse phase high performance liquid chromatography (HPLC) separated the PTH-rP activity from that of TGF-alpha and the bone resorbing activity in vitro was found only in the fractions of PTH-rP. It was concluded that this breast cancer produced PTH-rP as well as TGF-alpha, and the former was thought to have a major role to play in the humoral hypercalcemia of malignancy observed in this patient.

[Peculiarity of pulsed dye laser lithotriptor and its clinical application].

Ultrasound lithotriptors (USL) and electrohydraulic lithotriptors (EHL) are representative lithotriptors for endoscopic elimination of upper urinary tract stones. However, they have some disadvantages. For example, USL can not be used with flexible scopes and EHL can cause unexpected tissue injury. To overcome these problems, the pulsed dye laser lithotriptor (MDL-1, Candera Co.) was developed. The characteristics of this laser lithotriptor and its direct effects on tissue was investigated. This pulsed dye laser lithotriptor generates a 504 nm wavelength green light beam by using a combination of a xenon flash lamp and the greenish dye composed of coumarin solution. The maximum output energy is 60 mJ/pulse and the pulse duration is 1.5 microsecond. The pulse rate can be varied from 1 to 20 Hz. First, the intensity of the shock wave was measured by using a combination of a piezoelectric element and an oscilloscope, and then, the results were compaired with those obtained by a similar experiment with an EHL. The average intensity of the shock wave was 54.4 mW under the conditions of 40 mJ/pulse of output energy and 10 Hz of pulse duration. On the other hand, the EHL generated an average of 54.7 W under the conditions of 400 mJ/pulse output energy. Then, fragmentation of various kinds of urinary stones in saline solution was performed. The results showed that this lithotriptor could fragment almost all kinds of stones except cystine stones. Then, hen's eggs were used to observe the effect if laser bean influenced on the organism immediately behind the photoradiated object. Only the egg shell was demolished but the egg membrane below the eggshell did not undergo any change. After these experiments, skin, liver, kidney and urinary bladder of nude mice and human prostatic urethral mucosa in case of TUR-P were irradiated by this laser. The results showed that laser energy caused slight penetration and localized hemorrhage from the surface of epithelium to subcutaneous tissue. It was confirmed that these effects were generated when the tip of the quartz fiber was in direct contact with the object.(ABSTRACT TRUNCATED AT 250 WORDS)