Postrenal acute renal failure during pregnancy 20 years after antireflux surgery.

We report that a 27-year-old woman with bilateral severe hydronephorosis during pregnancy 20 years after antireflux surgery. The patient developed postrenal acute renal failure due to obstruction of the lower ureter. This patient could safely give birth after bilateral percutaneous nephrostomy through joint management with the obstetrics and gynecology staff. We describe that stenosis of the lower ureter is a late complication of antireflux surgery.

Influence of urinary sialic acid on calcium oxalate crystal formation.

Using seed crystal method, whole-urine method, and scanning electron microscopy, the inhibitory effects of sialic acid and osteopontin (OPN) on aggregation/growth of CaOx crystals were investigated. Using the seed crystal method, sialic acid showed an inhibitory effect on CaOx crystal aggregation/growth in a concentration-dependent manner, but almost no effect was observed using the whole-urine method. OPN showed an inhibitory effect on aggregation/growth in both experimental systems. The inhibitory effect of asialo-OPN on aggregation/growth was approximately 20% lower than that of OPN in the experiment using the seed crystal method and approximately 15% lower in the experiment using the whole-urine method. Scanning electron microscopy showed that OPN and sialic acid inhibit the aggregation of CaOx crystals. The above findings show that sialic acid accounts for about 15-20% of the involvement of OPN in CaOx crystallization.

[Renal transplant blood flow measurement using ultrasonic contrast agents].

We studied the renal transplant blood flow using an ultrasonic contrast agent. The contrast medium was injected intravenously and produced blood flow enhancement for at least 60 seconds. Measurements were made from the recorded Doppler spectra. Fourteen renal transplant recipients were investigated by color Doppler echography. Blood flow in the interlobular artery could be analyzed in all patients using a contrast, agent, as compared with 2 patients (14%) by a conventional method. The average maximum and minimum flow velocity of the interlobular arteries were 0.15 m/sec and 0.04 m/sec. In conclusion, an ultrasonic contrast agent is useful to accurately evaluate peripheral blood supply in renal transplants.

[Chiari I. malformation, a new childhood disease?]. / Chiari I. malformáció, egy "új" gyermekbetegség?

From July 1, 1994 to July 1, 1997 a total of 17 children with Chiari I malformation diagnosed by MRI was seen in our hospital. Six of them underwent craniocervical decompression and tonsilar resection. The major complaints of all these children were gait ataxia and persisting (longer than 6 month) headache, and one child had acutely presenting vertigo and problem of swallowing. The MRI showed that in all cases the tonsils were displaced below the level of CI. Hydrocephalus or syrinx was not seen. At surgery the tonsils were resected. All the patients can be considered cured and symptom free at an average follow up of 13 month.

Effect of ethyl icosapentate on urinary calcium and oxalate excretion.

BACKGROUND: The effect of ethyl icosapentate (EPA-E) on urinary calcium and oxalic acid excretion was examined to evaluate whether EPA-E is useful in the prevention of calcium-containing urinary stones. METHODS: For 6 months, urine was measured daily from 40 calcium-containing urinary stone producers at an outpatient clinic, before and after the administration of 1800 mg/day EPA-E. The urine was measured for volume, urea nitrogen, creatinine, calcium, magnesium, phosphorus, uric acid, oxalic acid and citric acid. Serum total cholesterol and triglyceride were also measured. RESULTS: Urinary calcium excretion was not reduced in any of the patients or particular hypercalciuric groups, nor did the level of calcium change. However, nine of the 25 hypercalciuric patients experienced a significant urinary calcium reduction to the normal calciuric level (a reduction of approximately 44%). It is not known why these particular patients experienced a reduction. Urinary oxalic acid did not change, whether hypercalciuria was present or not. CONCLUSIONS: These findings suggest that EPA-E is not particularly effective in reducing urinary calcium excretion in the hypercalciuric patients, but it needs future investigation because some patients experienced significant urinary calcium reduction.

Venous hemangioma of the scrotum: a case report.

We report a case of intrascrotal hemangioma. A 68-year-old man who had noticed a swelling in his left scrotum over the past 1 year was seen at our hospital. Under a diagnosis of intrascrotal tumor, total excision of the mass was performed. Histopathological examination revealed venous hemangioma of the scrotum.

Localization and inhibitory activity of alpha(2)HS-glycoprotein in the kidney.

alpha(2)HS-Glycoprotein (HS), a crystal surface binding substance extracted from human urine, is considered to be one of the urinary macromolecular inhibitors in urolithiasis. In the present study, reverse transcription-polymerase chain reaction was used to examine HS mRNA expression, and immunohistochemical staining was used to reveal its localization in the human kidney. The inhibitory effects of recombinant human HS and native human HS on calcium oxalate crystal growth were examined in a seed crystal system. HS mRNA was found to be expressed in the human kidney, and it was located in the epithelial cells of distal and proximal renal tubular cells. However, neither recombinant HS nor native HS had an inhibitory effect on crystals in the protein concentration of urine of healthy humans. HS in the urine, therefore, does not seem to be a potent inhibitor in stone formation.

[Endopyelotomy with ureteral cutting balloon device: long-term follow up of 13 patients].

BACKGROUND: This study investigated the feasibility and long term results of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction. METHODS: Thirteen patients (primary: 12, secondary: 1, male: 7, female: 6, mean age: 36) with UPJ obstruction were treated by the Acucise under fluoroscopic guidance. After cutting the stenotic area electrically using cutting wire and dilatation by the balloon, ureteral catheter (7-14 Fr) was inserted for 6-8 weeks. RESULTS: The mean operative time was 43 minutes, the median postoperative hospital stay was 4 days. The subjective success rate (disappearance of the abdominal pain) was 92% (11/12) and the objective success rate evaluated by radiographic studies was 62% (8/13). One patient needed a transfusion but no other major complication occurred in the treatment. The failure 5 patients were now under conservative follow up. CONCLUSION: Our limited data suggest that endopyelotomy with the Acucise device offer lower morbidity with slightly lower success rate compared other endopyelotomies. We believe that Acucise endopyelotomy can be an appropriate one of the first-line therapy for UPJO.

Interaction between osteopontin on madin darby canine kidney cell membrane and calcium oxalate crystal.

We recently reported that the addition of the protein osteopontin (OPN) resulted in an increase in the deposition of calcium oxalate (CaOx) crystals on the surface of Madin Darby canine kidney (MDCK) cells. To determine the degree to which this increased deposition is caused by OPN, we investigated the extent to which the CaOx crystal deposition produced by the expression of OPN at the cell surface was suppressed by 4 different methods prior to the determination of the level of CaOx crystal binding. MDCK cells (2 x 10(6) cells/well) were cultured to a confluent state, and the binding of OPN to the cellular surface was then inhibited by adding one of the following 4 substances: human OPN polyclonal antibody, thrombin, cyclic Arg-Gly-Asp (RGD) peptides and tunicamycin. The cells were cultured for 24 h. We then used a fluorescent antibody technique with an OPN polyclonal antibody to determined whether the expression of OPN at the cell surface was inhibited, and we measured the degree of CaOx crystal deposition using the isotope (45)Ca. The degree of CaOx crystal deposition was inhibited by 80% or more in the antibody-treated group, by 50-80% in the thrombin-treated group, by 60-80% in the cyclic RGD-treated group, and by 50-60% in the tunicamycin-treated group. These results suggest that OPN in the extracellular matrix is the main cause of CaOx crystal deposition on the surface of MDCK cells.

[A case of primary transitional cell carcinoma of the prostate].

We report a rare case of primary transitional cell carcinoma of the prostate. A 66-year-old man was referred to our hospital with the chief complaints of pollakisuria and residual urine sensation on January 21, 1998. Under a preoperative diagnosis of benign prostatic hyperplasia, transurethral resection of the prostate was performed. Histopathological examination revealed grade 3 transitional cell carcinoma. Then the transrectal needle biopsy of the prostate and random biopsy of the urinary bladder were performed. Since no metastatic tumors or tumor cells were detected in either the prostate or urinary bladder or any other organs, this patient was diagnosed with primary transitional cell carcinoma of the prostate. Three courses of adjuvant chemotherapy (M-VAC) were performed, and tumor recurrence was not recognized 9 months after the operation. This is the 35th case of primary transitional cell carcinoma of the prostate in the Japanese literature.

[Endopyelotomy with Acucise for secondary ureteropelvic junction obstruction: report of a case].

We report a case of successful endopyelotomy using the Acucise cutting balloon device for secondary ureteropelvic junction obstruction (UPJO). A 23-year-old man was hospitalized with the chief complaint of left lumbago and left hydronephrosis due to left UPJO. He underwent antegrade endopyelotomy with a nephroscope and open pyeloplasty. However, left lumbago and hydronephrosis did not show improvement. Acucise endopyelotomy was performed under epidural anesthesia. The operative time was 55 minutes and the hospital stay after the operation was 4 days. There were no operative complications and 3 months later, the operative results were satisfactory as determined by drip infusion pyelography and the disappearance of the lumbago.

[A new technic in the management of hydrocephalus: neuro-endoscopy]. / Uj esély az agyvíz keringési zavarok kezelésében: neuroendoszkópia.

Conventional valve shunting for treatment of hydrocephalus has a high rate of long-term complication. After a brief historical review of neurosurgical endoscopy the authors present the different indications and methods of neuroendoscopy. Between 1995 and 1997 twenty-two pediatric patients underwent endoscopic surgery at National Institute of Neurosurgery. Twelve of them had third ventriculo-cistemostomy, and cystic wall fenestration was performed in ten children. All but one patient benefited from this minimally invasive endoscopic technic. Minor transient complications were seen in three cases, and only one patient had long-term pupillary dilatation due to the surgical procedure.

[Two cases of renal cell carcinoma detected by metastasis to another organ].

Two cases of rare metastases from renal cell carcinoma are reported. The first case was in a 44-year-old man presenting with left exophthalmos. Radiological examination revealed left renal tumor with metastases to paraaortic lymph nodes, left orbit, bone and lungs. Radical nephrectomy was performed. Pathological diagnosis was renal cell carcinoma, pT3aN2M1. The patient died of widespread pulmonary metastasis 5 months postoperatively. The second case was in a 59-year-old man with a complaint of tongue tumor. Histopathology of the enucleated tumor was suggestive of metastatic renal cell carcinoma. Computed tomographic scan revealed left renal tumor with regional lymph node metastasis. No other metastasis was found. Radical nephrectomy confirmed the pathological diagnosis of renal cell carcinoma, pT3bN1M1. He has been treated with interferon-alpha and has been free of recurrence for 10 months postoperatively.

[Endopyelotomy with the ureteral cutting balloon device for ureteropelvic junction obstruction].

BACKGROUND: This study investigated the feasibility of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction. METHODS: Six patients (male: 3, female: 3, age: 6-18) with UPJ obstruction and abdominal pain as the chief complaint, were treated by the Acucise ureteral cutting balloon device (flexible ureteral catheter, 7 Fr) under epidural or general anesthesia (for the 6-year-old girl only). After cutting the stenotic area electrically and posteriolaterally using a 3 cm cutting wire and dilation by the balloon to a maximum of 24 Fr for 10 seconds, a 6/10 Fr (for children) or 7/14 Fr (for adults) endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. After removing the ureteral catheter transurethrally, the results, including the patency of the UPJ, of this procedure were evaluated by intravenous pyelography and the disappearance of the chief complaint, abdominal pain, 12 weeks after removing the ureteral catheter. RESULTS: Mean operative time was 47 (25-90) minutes and the hospital stay after the operation was 5.3 (3-14, median: 4) days. There was no transfusion or emergent open operation for uncontrolled bleeding in this series. The results 20 months after the operation: improvement of hydronephrosis was shown in 4 patients (66.7%) on intravenous pyelography and abdominal pain disappeared in all patients. CONCLUSION: UPJ obstruction may be easily and safely treated by retrograde endopyelotomy with the Acucise ureteral cutting balloon device. The principal potential advantage of this procedure is reduced morbidity compared to that with antegrade or retrograde endopyelotomy by endoscopy.

[Continent urinary reservoir using dilated renal pelvis of non-functioning pelvic kidney in a girl with cloacal exstrophy].

We performed construction of continent urinary reservoir in an 8-year-old girl with cloacal exstrophy who had double stoma of ileostomy and colon conduit. Preoperative evaluation revealed non-functioning right kidney with severely dilated renal pelvis and calyxes in her pelvis. Urinary reservoir was constructed using detubularized colon segment which had been used as the urinary conduit and dilated renal pelvis of non-functioning pelvic kidney. Using Mitrofanoff's principle, continent catheterizable channel was also made of the anterior wall of the renal pelvis. Postoperative course was uneventful. Reservoir capacity increased to 350 ml one and half year postoperatively and she is almost dry with clean intermittent catheterization 5 times a day. Dilated upper urinary tract is one of the ideal material for bladder enlargement that avoids the complication associated with the use of gastrointestinal tract.

[Sialic acid determinations of serum and urine specimens in calcium-containing urinary stone formers].

PURPOSE: The aim of the present study was to compare sialic acid concentrations of serum and urine specimens in both calcium (Ca)-containing urinary stone formers and non-stone formers. Moreover, we studied inhibitory activity of sialic acid upon the calcium oxalate (CaOx) crystal aggregation and growth. MATERIALS AND METHODS: Sialic acid determinations were done on fresh serum and urine samples of 35 Ca-containing urinary stone formers (stone formers group) and 20 non-stone formers (patient controls group). Inhibitory activity of sialic acid upon the CaOx crystal aggregation and growth was studied by using in vitro assay method of seed crystal system. RESULTS: Serum sialic acid concentrations were found to be similar in the two groups. Urinary sialic acid concentrations were significantly lower in the urine specimens of stone formers than in their patient controls. Sialic acid showed a dose dependent inhibitory activity upon the CaOx crystal aggregation and growth into seed crystal method. CONCLUSION: It is suggested that urinary sialic acid may play some role during the phase of stone formation from the results of the present study, because sialic acid shows marked inhibitory activity upon the CaOx crystal aggregation and growth at concentrations higher than 100 mg/dl.

[Ectopic ureter opening in the vestibulum without urinary incontinence: a case report].

A case of ectopic ureter without urinary incontinence despite its ureteral orifice in the vestibulum is reported. A 2-year-and-9-month-old female was referred to our hospital with the pain of external genitalia, pollakisuria and macroscopic hematuria. Examination revealed a complete double system of the left upper tract with vestibular opening from the upper moiety. She did not show any signs of ureteric incontinence after the establishment of voiding habits. Because radioisotope (RI) scintigram showed apparent uptake in the upper half of the left kidney we performed left ureterocystoneostomy with psoas hitch procedure. We postulate that the incontinence mechanism is maintained when the running course of the ectopic ureter is through some portion of the urethral sphincter musculature. This is the 10th case reported in Japan.

[A case of renal cell carcinoma of the native kidney following cadaveric renal transplantation].

A case of renal cell carcinoma of the right native kidney following cadaveric renal transplantation is reported. A 44-year old male underwent cadaveric renal transplantation in 1993 and had stable graft function, but he had suffered from hypertension before the renal transplantation and multiple antihypertensive medications were not effective. Abdominal computed tomography demonstrated bilateral contracted kidneys, but we could not rule out renal cell carcinoma of the right kidney, completely. Angiography of the graft artery revealed no stenosis and venous sampling suggested that plasma renin activity was increased in the left renal vein. Thus we performed bilateral native nephrectomy. Histology of the right kidney was renal cell carcinoma, clear cell subtype, grade 1, pT2, and the left kidney was end stage of renal disease. Because of high incidence of malignant neoplasia after renal transplantation, routine careful examination is quite important.

[A case of bilateral testicular torsion in a neonate].

A case of testicular torsion in the newborn is presented. A 8-day-old infant with bilateral intrascrotal swelling since birth was referred to us. Bilateral testicular torsion was suspected and operation was carried out at the same day. We operatively found extravaginal torsion of the bilateral spermatic cord. The bilateral testis appeared extensively necrotic, but we repaired the torsion and performed bilateral orchiopexy because of bilateral torsion. We could not palpate well the bilateral testis in one year, probably due to an atrophy. Sixty-nine cases of testicular torsion in the newborn including our case from Japanese literatures were reviewed and discussed. Especially forty-seven cases were presented at birth.