Hemiresective reconstruction of a redundant ileal conduit with severe bilateral ileal conduit-ureteral reflux

A 58-year-old man was referred to our hospital with high fever and anuria. Since undergoing a total pelvic exenteration due to bladder-invasive sigmoid colon cancer, urinary tract infections had frequently occurred. We treated with the construction of a bilateral percutaneous nephrostomy (PCN), and chemotherapy. Although we replaced the PCN with a single J ureteral catheter after an improvement of infection, urinary infection recurred because of an obstruction of the catheter. Urological examinations showed that an ileal conduit-ureteral reflux caused by kinking of the ileal loop was the reason why frequent pyelonephritis occurred. We decided to resect the proximal segment to improve conduit-ureteral reflux for the resistant pyelonephritis. After the surgery, the excretory urogram showed improvement and the urinary retention at the ileal conduit disappeared. Three years after the operation, renal function has been stable without episodes of pyelonephritis. Here we report a case of open repair surgery of an ileal conduit in a patient with severe urinary infection.     

Assessing genetic susceptibility to diabetic nephropathy

SUMMARY:   Diabetic nephropathy is a serious complication of diabetes and the leading cause of end-stage renal disease. Studies indicate both environmental and genetic factors contribute to the development and progression of diabetic nephropathy. In particular, epidemiological evidence shows a familial clustering of nephropathy in siblings with diabetes, supporting an important role of genetic susceptibility in the pathogenesis of diabetic nephropathy.
A common approach in genetic research is assessment of candidate gene polymorphisms using case-control analysis; a number of studies have evaluated predictable candidate genes for diabetic nephropathy. In contrast, only a few studies have used a whole genome approach, such as scanning of micro-satellite markers, in the assessment of genetic susceptibility to diabetic nephropathy. A whole genome linkage analysis using families of Pima Indians showed susceptibility loci for diabetic nephropathy on chromosome 3, 7, and 20. Another linkage analysis using discordant sib-pairs of Caucasian families with type 1 diabetes identified a critical area on chromosome 3q. However, these results have been inconclusive and further investigation is required.
Recently, a genome-wide, case-control analysis identifying susceptibility genes for diabetic nephropathy was performed. As a result, a single nucleotide polymorphism in exon 23 of the solute carrier family 12 (sodium-chloride cotransporter) member 3 gene was found to be strongly associated with diabetic nephropathy. Although further assessment of this polymorphism is needed, this strategy offers great promise in the identification of genetic factors predisposing patients to diabetic nephropathy. Identification of genetic susceptibility markers may offer new hope in the diagnosis and treatment of diabetic nephropathy.     

A New Technique for Endoscopic Esophageal Mucosectomy Using a Transparent Overtube with Intraluminal Negative Pressure (np-EEM)

Abstract: We devised a new technique for endoscopic esophageal mucosectomy using a transparent overtube (OT) with intraluminal negative pressure (np-EEM) (Figs. 1,2). Basic studies were performed on six dogs. The following two methods were utilized in the np-EEM technique in line with standard approaches used for mucosal resection: (1) A “snare” method was used in which the esophageal mucosa protruded, similar to a polyp, through the slit of the OT and was resected by an electro-snare passing through the endoscope biopsy channel or the injection channel of the OT. A high-frequency current was used for the resection (Figs. 2-a 2-b, Fig. 3, Color). (2) A “cutter” method was used in which the mucosal protrusion was resected by a recently developed electro-cutter (Figs. 2-a, 2-c, 2-d, Fig. 3, Color). A mucosal protrusion, similar to a polyp, can be caused by intraluminal negative pressure at any point in the esophageal area. Mucosa up to 1.5 cm in diameter can be resected by both methods (Tables 1, 2; Figs. 5, 6, 7). The cutter method showed many advantages in terms of the ease of procedure, predictablility, and the ability to control the width and depth of the resection. Therefore, np-EEM, especially using the cutter method, has significant advantages for application with esophageal mucosal lesions for both diagnosis and treatment.     

Verruciform xanthoma in association with a vulval fibroepithelial polyp

Summary We report the clinical, light microscopic, immunohistochemical and ultrastructural features of a verruciform xanthoma that developed in association with a vulval fibroepithelial polyp. To our knowledge, this is the first time that this association has been reported. Immunohistochemical findings confirmed that the xanthoma cells were of a monocyte/macrophage lineage. In addition to typical histological characteristics, prominent vascular ectasias were detected in the deep dermis at the periphery of this lesion. The ectasias may play a part in pathogenesis.     

Origin of neovascular structure in an early stage of hepatocellular carcinoma: Study of alpha-smooth muscle actin immunohistochemistry in serial thin sections of surgically resected cancer

Background: To elucidate the origin of the neovascular structure found in well‐differentiated hepatocellular carcinoma (HCC), an immunohistochemical study was performed on sequential thin section specimens. Method: Eleven surgically resected specimens of well‐differentiated HCC were analyzed for neovascular structure using monoclonal alpha‐smooth muscle actin (α‐SMA) antibody. Each paraffin specimen was serially sliced to a thickness of 3 µm for immunohistochemistry. When a ring‐shaped structure was found unrelated to portal triads on α‐SMA staining, it was regarded as abnormal neovascularity (non‐triadal vessel or unaccompanied vessel). Results: All of the 11 liver cancers had thin‐walled, round‐ or oval‐shaped non‐triadal vessels in their well‐differentiated parts. Immunohistochemistry of serial thin sections of HCC showed that these non‐triadal vessels were connected to portal veins in portal triads in well‐differentiated cancer in a total of nine patients (81.8%). This type of neovascular structure found in a well‐differentiated cancer seemed to be a surviving portal vein among diminishing and disappearing arteries and bile ducts. All 11 tumors showed isovascular staining on ordinary digital subtraction angiography, and four of the tumors showed negative enhancement on intra‐arterial carbon dioxide‐enhanced ultrasonography or computerized tomographic (CT) hepatic arteriography, suggesting a relative arterial blood scarcity in the tumor nodules. Conclusion: At an early stage of HCC, non‐triadal vessels originate from ordinary portal veins in intratumoral portal triads. This fact sufficiently explains the reason why a well‐differentiated liver cancer can sometimes show arterial blood paucity on CT arteriography or enhanced ultrasonography.     

A case of renal cell carcinoma with multiple lung metastases refractory to interferon-α showing complete remission by interleukin-2 monotherapy

We report a case in which a regimen of interleukin-2 (IL-2) achieved pathologically complete remission against renal cell carcinoma with multiple lung metastases. A 63-year-old man was admitted to the Osaka University Hospital with a right renal tumor and multiple lung metastases. Right radical nephrectomy was performed and the histological diagnosis was clear cell carcinoma, G3 > G2, INFbeta, pT3a, pN0. Postoperatively, despite treatment with interferon-alpha, the lung metastases progressed. Consequently, intravenous administration of IL-2 was started at a dose of 70 x 10(4) JRU/day five times per week. After 16 weeks of IL-2 therapy, most of the multiple lung metastases completely vanished and the largest metastatic lung mass was reduced in size. Resection of this residual lung mass was performed and pathological examination revealed no viable cancer cells.     

Season of birth of schizophrenics in a recent Japanese sample

Abstract  An excess of schizophrenic births in winter or early spring is a well replicated finding in studies on Western populations. However, there are few studies on Asian populations, and their results are not consistent. We examined the seasonality of schizophrenic births in Japanese subjects ( n = 1024) born between 1955 and 1960. Our results showed a significant inverse relationship between temperature and number of schizophrenic births, which is in line with the findings in Western populations. In our data, observed reduction of schizophrenic births in summer was more marked than excess births in winter. We suggest the possibility that birth in summer may have some advantage in brain growth early in life, which results in reducing the risk of developing schizophrenia.     

The relationship of DSM-III-R personality disorder to clinical variables in patients with major depression: Possible difference between personality disorder clusters

Abstract The relationship of DSM-III-R personality disorder (PD) to demographic and clinical variables was investigated based on 96 consecutive outpatients with major depression. No significant difference in the variables was found between those with and those without PD. Those with PD from each cluster were compared with those without PD in terms of the variables. In these comparisons many relationships of PD to the variables were found, and these relationships were different between the three PD clusters detailed in DSM-III-R. Patients with cluster B PD demonstrated a prominent uniqueness in his/her relationship to the variables. This uniqueness was similar to what had been reported previously with regard to patients with PD. There was no significant difference in the variables between those with cluster C PD and those without PD. Those with cluster A PD may have a negative family history of affective disorders.