A genotypic male with anorchia in conjunction with isolated idiopathic hypogonadotropic hypogonadism.

We report a case of anorchia in conjunction with isolated idiopathic hypogonadotropic hypogonadism. Plasma levels of LH, FSH, TSH and testosterone were abnormally low. Administration of human chorionic gonadotropin caused no increase in plasma testosterone, and injection of luteinizing hormone-releasing hormone resulted in no change in plasma gonadotropins. We discuss the embryology and hormonal status of this patient.

Inhibitors of collagen synthesis and hypophysectomy: effects on androgen induced growth of ventral prostate in rats.

To elucidate the effect of decreased amounts of collagen on prostatic growth, beta-aminopropionitrile, one of the agents that selectively inhibit collagen formation, was administered, with or without exogenous androgen and/or hypophysectomy, to rats of varying ages. The weight of the ventral prostate and the collagen content and the ratio of type III to type I collagen in the ventral prostate were examined. Administration of beta-aminopropionitrile, with or without exogenous androgen, reduced the collagen content in the ventral prostate in any age groups, but increased the weight of the ventral prostate only in young rats. Administration of beta-aminopropionitrile to hypophysectomized rats did not change the weight and collagen content. Administration of beta-aminopropionitrile prevented androgen-induced growth of prostatic collagen, resulting in increased prostatic weight in young rat. The ratio of type III to type I collagen in the rat ventral prostate remained unchanged by administration of beta-aminopropionitrile, exogenous androgen, hypophysectomy, or advancing age. It would appear that in young rats prostatic collagen plays an important role in suppressing prostatic growth. The ratio of type III to type I collagen is stable under various experimental conditions in the ventral prostate.

Cryptorchidism, micropenis and clinical anophthalmia epilepsy in a retarded boy.

A boy was found to have bilateral anophthalmia at birth. General health examination revealed cryptorchidism and micropenis. Physical and mental retardation in addition to epilepsy were observed. Karyotype showed 47, XY. No report has ever described such a case of dysmorphic syndrome.

Cytomegalovirus-associated hepatitis and duodenal ulcer in kidney allograft recipients.

We report here on two patients with kidney allografts who had hepatitis and duodenal ulcer caused by cytomegalovirus. In one case, hepatosplenomegaly and jaundice appeared after high fever lasting for ten days. Laboratory examinations showed liver dysfunction and lymphocytosis with atypical forms. Virological studies revealed cytomegalovirus infection and we successfully treated the patient with human interferon-beta. In the other case, duodenal bleeding followed by interstitial pneumonia occurred at the 54th day after transplantation. Bleeding from the small duodenal ulcer did not stop in spite of conservative and endoscopic therapies, and gastrectomy was performed. Histologically many epithelial cells with intranuclear inclusions were found around the ulcer. Virological studies showed elevation of antibody titres to cytomegalovirus which was isolated from the urine and oropharyngeal secrete. After gastrectomy and treatment with ganciclovir, the general condition improved and graft function was maintained. Our experience with these cases suggests that aggressive diagnostic investigations for cytomegalovirus infection are essential in patients with organ allografts who present liver and gastrointestinal lesions.

Changes in serum levels of prostatic acid phosphatase and prostate specific antigen after luteinizing hormone-releasing hormone analogue administration in patients with metastatic prostatic cancer in relation to glandular differentiation.

Eighteen previously untreated patients with metastatic carcinoma of the prostate were treated with LHRH analogue. They were divided into 3 groups according to the degree of glandular differentiation. In all groups, a transient rise of PAP and PSA was observed after the LH and testosterone surge. However, relative values of LH, testosterone, PAP and PSA did not differ significantly among the 3 groups. These facts suggest that a transient rise of PAP and PSA is caused by testosterone surge independently from the degree of glandular differentiation after LHRH analogue administration in patients with advanced prostatic cancer.

Phentolamine test for operative complications of pheochromocytoma: its prognostic importance.

The purpose of this investigation was to assess whether the phentolamine test is able to predict blood pressure fluctuations during operations on patients with pheochromocytoma. We administered 5 mg phentolamine intravenously to 11 patients with pheochromocytoma and 6 patients with essential hypertension, pretreated with alpha-adrenoceptor antagonists. Plasma concentrations of epinephrine and norepinephrine were determined before and after phentolamine administration, and blood pressure was measured repeatedly. Subsequently, all patients with pheochromocytoma underwent adrenal operations. Evidence is presented to show that: (1) in patients with pheochromocytoma whose blood pressure remains stable during their operation, phentolamine produces no clear effects on mean blood pressure (MBP), plasma epinephrine and plasma norepinephrine except in one patient with Sipple's syndrome, (2) in patients with pheochromocytoma exhibiting unstable blood pressure changes during surgery, phentolamine lowers MBP and raises plasma norepinephrine and (3) in patients with essential hypertension, MBP and plasma catecholamines remain unchanged following phentolamine administration. Based on these findings, this pharmacological test appears to be useful for predicting hemodynamic stability in patients with pheochromocytoma pretreated with alpha-adrenoceptor antagonists.

Modulation of the urethral pressure by high-frequency block stimulus in dogs.

Nerve conduction block by high-frequency stimulus has been used as a method to modulate the contractile force of skeletal muscles. This paper describes the effect of block stimulus on the modulation of urethral closure pressure in dogs. Tetanic stimulus was applied through a pair of electrodes wrapped about the bilateral pudendal nerves and high-frequency stimulus was superimposed through another pair of electrodes wrapped about 1 cm distalward along the nerves. Urethral closure pressure was measured through a transurethral UPP catheter. High-frequency stimulus over 300 Hz reduced elevated urethral closure pressure, which was induced by tetanic stimulus, up to 30-45%.

Pericentric inversion of chromosome 9 associated with Sertoli-cell-only tubule.

We report a case of pericentric inversion of chromosome 9 associated with Sertoli-cell-only tubule. The literature is reviewed, and the hormonal profile and testicular histology are discussed.

Hormone profiles and contralateral testicular histology in Down's syndrome with unilateral testicular tumor.

Hormonal profiles and testicular histology were studied in two patients with Down's syndrome with unilateral testicular tumor. Plasma levels of LH and FSH were elevated above normal ranges in both cases. In case 1, plasma testosterone level was abnormally low, but prolactin level in plasma was within the normal range. Case 2 showed elevated concentration of plasma prolactin and normal level of plasma testosterone. The administration of LH-RH resulted in low response of plasma gonadotropins. The response of plasma testosterone to the administration of HCG was abnormally suppressed in both cases. Testicular histology showed reduction of Johnsen score count and tubular diameter, and an increase in wall thickness. These results indicated that male patients with Down's syndrome have an abnormality in hypothalamo-pituitary-gonadal axis.

Membranous lipodystrophy (Nasu's disease): a rare cause of neuropathic urinary incontinence.

A 37-year-old man with membranous lipodystrophy (Nasu's disease) was urodynamically studied, to elucidate his urinary incontinence. Although medication failed to improve this unfavorable condition, urodynamic assessment of this patient clearly demonstrated the existence of an uninhibited overactive bladder.

Non-Hodgkin lymphoma mimicking primary retroperitoneal tumour on computed tomography.

We report a case of non-Hodgkin lymphoma with CT showing a single, bulky, and round retroperitoneal mass mimicking primary retroperitoneal tumours or metastatic lymph node. On MRI, the tumour was presumed originating from lymph nodes but we could not judge whether the tumour was due to lymphoma or metastasis.

Incidence of anal incontinence after long-term follow-up of patients treated by ureterosigmoidostomy.

Twenty-eight patients who had been treated with ureterosigmoidostomy after radical cystectomy were examined with special reference to anal incontinence. In the present series, 17 out of 28 patients (60.7%) had daytime and/or nighttime anal incontinence. In these patients preoperative function of the external and sphincter was considered to be sufficient. Anal incontinence occurred immediately after operation in only 3 patients. Incontinence emerged at an average duration of 2.6 years after ureterocolonic anastomosis. Incidence of anal incontinence after ureterosigmoidostomy appeared to be influenced by aging.

Quantitative analysis of bone metastasis in prostate cancer.

A new method of quantitative analysis of bone metastasis in prostate cancer is described. By using a variance-dependent filter and a smoothing filter, the increased uptake lesions were distinctly demonstrated on the bone scintigraphy. The images were divided into several areas and analyzed. These procedures resulted in a clear identification of the metastatic lesions. Repeated measurements of the metastatic areas from the same scintigrams disclosed a high reproducibility. This method appears to be highly consistent and clinically applicable.

Electrical pelvic floor stimulation in the management of urinary incontinence due to neuropathic overactive bladder.

Electrical pelvic floor stimulation employing a portable functional electrical stimulation system with percutaneously indwelling electrodes was carried out to improve detrusor urinary incontinence. Cyclic stimulation using negative going pulse trains of 20 Hz was applied 3 to 6 times daily to the bilateral pudendal nerves distributing to the pelvic floor muscles for the purpose of strengthening these muscles, including the urethral sphincter, and simultaneously, suppressing detrusor overactivity and increasing cystometric capacity. Electrical training for 4-8 weeks resulted in an improvement of urinary incontinence in five of six patients. In two of six cases incontinence had subjectively disappeared. Urodynamic investigations demonstrated an increase in detrusor reflex threshold and less tendency for abortive detrusor contraction. No apparent complications were encountered during these periods. This procedure appears to be efficient for the management of patients with detrusor incontinence who respond poorly to conservative therapies.

Nerve conduction velocities and hair concentrations of trace elements in haemodialysis patients.

Nerve conduction velocities and hair concentrations of trace elements were studied in 19 male patients with chronic renal failure undergoing haemodialysis. Both motor and sensory nerve conduction velocities were significantly lower in haemodialysis patients as compared to controls (p < 0.001). Calcium and aluminium concentrations were significantly higher in patients (p < 0.01), however, vanadium and arsenic levels were significantly lower in patients (p < 0.01). In concentrations of copper and zinc there was no significant difference between patients and controls. There were no significant correlations between hair concentrations of trace elements and nerve conduction velocities except between calcium concentration and sensory nerve conduction velocity. These facts suggest that nerve conduction velocities are not influenced by changes of trace element concentrations in hair in patients with chronic renal failure undergoing haemodialysis.

Successful hyperbaric oxygenation for radiation cystitis due to excessive irradiation to uterus cancer.

Six female patients with radiation cystitis, induced by previous pelvic radiation to uterus cancer, were treated with hyperbaric oxygenation (30-35% of oxygen concentration at 2 atmospheric absolute pressures for 90-120 min daily from 20 to 61 days with the average of 45 +/- 7 days, mean +/- standard error). Except in 1 patient symptoms and cystoscopic findings were improved. No side effects were found. Recurrence of radiation cystitis never occurred during the follow-up period (1.0 +/- 0.1 years). Hyperbaric oxygenation treatment in this pressure environment appears to have a beneficial effect of this disorder.

An azoospermic male with reciprocal translocation t(3;4)(p12;q21).

We report a case of autosomal translocation associated with azoospermia. The literature is reviewed, and hormone condition and testicular histology are discussed.

Terodiline in the treatment of nocturnal enuresis in children.

The effect of terodiline was investigated in 17 children with nocturnal enuresis. Twelve of them were evaluated urodynamically before treatment and 6 of these were proved to have detrusor instability with or without provocation. Terodiline in a daily dose of 12.5 mg was administered for 4 weeks. After treatment the number of wet nights per week has significantly decreased. Urodynamically, maximum cystometric capacity has statistically increased and in 2 patients involuntary contraction has disappeared. During these periods no serious side effects were encountered. Terodiline could improve urodynamic parameters in nocturnal enuresis. These changes appear to be favourable in clinical improvement.

Comparative biological activities of acellular pertussis vaccines produced by Kitasato.

The quality of 14 lots of acellular pertussis-diphtheria-tetanus (AC-PDT) vaccines manufactured by the Kitasato Institute during the period 1987-1990 were investigated. The geometric means of HSU, LPU, and BWDU were 0.078, 0.257, and 7.33 per ml respectively. The potency was higher than 14 IU per ml. These results indicated the consistency of the Kitasato AC-PDT vaccines. The antibody response to the AC-PDT vaccines was measured in primary and secondary vaccinated mice by ELISA. IgG antibody response to FHA and PT was obtained in all immunized mice (P less than 0.001) after the primary injection. In contrast, IgG antibody response to fimbriae 2 showed a significant titer rise (P less than 0.001) after the booster injection. The results indicated that the Kitasato AC-P vaccines consisted of protein, PT and FHA as the major antigens, and a little agglutinogen as the minor antigen.