[A patient with an ectopic ureteral opening diagnosed on the basis of pus discharge from the perineal region].

The patient was a 53-year-old woman with chief complaints of repeated pyrexia and pus discharge from the perineal region. A macroscopic examination revealed the presence of a fistula in the anterior wall of the vagina ; magnetic resonance imaging, retrograde urography through the fistula, and excretory urography indicated that the fistula was a complete left ureteral duplication with an opening on the anterior wall of the vagina. Laparoscopic ureterectomy of the left ectopic ureter was performed to achieve a complete cure. The ectopic ureteral opening led to a blind canal in the superior pole of the kidney. No postoperative complications were observed, and the symptoms disappeared. This is a rare case in which the patient, who did not have any symptoms until she became an adult, was diagnosed as having left ureteral duplication with the opening on the anterior wall of the vagina when pus was drained from the perineal region.

[Beta-hCG producing urothelial carcinoma of the urinary bladder: a case report].

A 74-year-old man visited our hospital presenting with pollakisuria. Cystoscopy revealed a bladder cancer with necrotic tissue. The patient was initially treated by transurethral resection of bladder tumor (TUR-Bt). Pathologically, the tumor was shown to be a carcinoma of bladder with human chorionic gonadotropin (hCG) positivity. After TUR-Bt, chemotherapy with M-VAC (methotrexate, vinblastine, adriamycine and cisplatin) was performed. This patient is still alive eight months after resection. To our knowledge, there are 37 cases of beta-hCG-producing urothelial carcinoma of the urinary bladder reported in the Japanese literature.

A malignant Leydig cell tumor of the testis.

A 40-year-old man was referred to our hospital with gynecomastia and painless swelling of the right scrotum. Ultrasonography revealed a 15 x 10 mm mass with low echogenicity of the right testis. We performed right high orchiectomy. Histologically, Reinke's crystals and capsular invasion by tumor cells were found. Final diagnosis, the tumor was a malignant Leydig cell tumor of the testis.

Neuronal excitation in the ventral tegmental area modulates the micturition reflex mediated via the dopamine D1 and D2 receptors in rats.

Involvement of the dopamine D(1) and D(2) receptors in the ventral tegmental area (VTA) in the micturition reflex was investigated using female Sprague Dawley rats under urethane anesthesia. Cystometrograms during continuous infusion of warmed saline into the bladder were recorded. When intervals of bladder contraction became constant, the excitatory amino acid DL-homocysteic acid (DLH) was microinjected into the VTA and changes in the cystometric parameters were observed. The selective D(1) antagonist SCH23390 (0.3 mg/kg) or D(2) antagonist eticlopride (0.1 mg/kg) was subcutaneously injected (s.c.) 15 min prior to the DLH treatment. A low dose of DLH (3 microg) facilitated the micturition reflex, whereas a high dose of DLH (30 microg) inhibited the micturition reflex. However, a middle dose of DLH (10 microg) did not show any effect. The facilitated micturition reflex induced by a low dose of DLH was inhibited by the selective dopamine D(2) antagonist eticlopride, but unaltered by SCH23390, a selective dopamine D(1) antagonist. In contrast, the inhibitory effect induced by a high dose of DLH on the micturition reflex was suppressed by SCH23390 but not eticlopride. These results suggested that the facilitated micturition reflex might be mediated via the dopamine D(2) receptors, while the inhibitory effects on the micturition reflex was mediated via the dopamine D(1) receptors.

Modification of ureteral motility and promotion of urine flow around an intraureteral obstruction by CL-316243, phenylephrine, and furosemide in dogs.

The aim of this study was to evaluate the effects of a beta3-adrenoceptor (AR) agonist (CL-316243), an alpha1-AR agonist (phenylephrine), and a loop diuretic (furosemide) on the spontaneous rhythmic contractions of the isolated canine ureter and on an acute ureteral obstruction produced by inflation of a balloon catheter in anesthetized dogs. In the isolated ureter, CL-316243 concentration dependently reduced both the amplitude and frequency of the rhythmic contractions (pD(2): 7.19 +/- 0.33), whereas phenylephrine significantly enhanced both variables (pD(2): 5.26 +/- 0.09) and furosemide reduced them only slightly. In the acute ureteral obstruction model, the intraureteral pressure (IUP) gradually rose to reach a plateau of 58.9 mm Hg after inflation of a balloon catheter within the lower ureter. Intravenous administration of CL-316243 (0.3 microg/kg) significantly reduced the elevated IUP and the resumed urine flow (UF), leading to a sustained reduction in the IUP. In contrast, the IUP continued to increase above the plateau level for 10 minutes after phenylephrine administration (10 microg/kg) and for 30 minutes after furosemide administration (1,000 microg/kg). In the phenylephrine group, the UF resumed when the IUP reached 75.8 mm Hg, and thereafter the IUP gradually decreased in parallel with the increase in the UF. From these results, we conclude that in dogs, CL-316243 reduces the IUP by allowing the UF to resume as a result of a relaxation of ureter at the obstruction site, whereas with phenylephrine, the reduction in the IUP is secondary to a resumption in the UF resulting from an induced contraction of ureter that causes an increase in hydrostatic pressure above the obstruction site.