Clinical manifestations of 25 patients with prostatic-type polyps in the prostatic urethra

To clarify the clinical manifestations of prostatic-type polyps (PP) in the prostatic urethra, a sample of 25 patients with PP who presented themselves to our hospital with hematuria or hematospermia was reviewed with respect to their symptoms and endoscopic findings. Recurrence of the conditions was also investigated. The patients were 26 to 68 years old, with a mean age of 48.5 years. Sixteen patients (64%) had hematuria and 8 (32%) had hematospermia. A bloody urethral discharge was observed in 6 patients (24%). Analysis of the character of the hematuria showed that total hematuria occurred in 44% of the patients. In 38% of the patients with hematospermia there was the additional symptom of post-ejaculatory hematuria. PP developed beside the verumontanum in 18 patients (72%), on the posterior urethral wall lateral to the verumontanum in 4 patients (16%), and on the verumontanum in 7 patients (28%). The prognosis could be investigated only in 22 (88%) of the 25 patients. Two patients (9%) experienced reccurrence during the follow-up period (1 to 5.8 years, mean: 3.7 years). Consequently, special attention should be paid to the possibility of PP in the prostatic urethra, particularly the verumontanum and nearby area, during endoscopic examination, when diagnosing patients with hematuria, hematospermia or with bloody urethral discharge.     

Incidence and duration of hoarseness following endotracheal intubation

The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. Most of there patients recovered within three days after surgery but in 4.2% the hoarshness persisted over ten days and in 0.7% persisted over one month after surgery. Most of these persistent hoarseness were considered to have originated from surgical procedures (such cervical, pulmonary, cardioaortic operation, etc.) and those following only tracheal intubation recovered within two months after surgery. The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.     

Effects of vascular injuries on hemostatic abnormalities in prolonged surgeries of maxillofacial malignant cancer

We evaluated the effects of surgical invasion and vascular injury on hemostatic abnormalities in seventeen ASA I-II patients undergoing prolonged surgeries of eight hours or more consisting of tumor excision, radical neck dissection and free flap reconstruction in the maxillofacial region. As molecular markers of blood coagulation and surgical invasion, prothrombin fragment 1 + 2 (F 1 + 2), interleukin-6 (IL-6), tissue-type plasminogen activator (tPA), thrombomodulin (TM) and plasmin alpha 2-plasmin inhibitor complex (PIC) were measured during surgery and on the first and second postoperative days. The F 1 + 2 values increased significantly during surgery and decreased postoperatively, and reached the maximum at the end of surgery. Changes in IL-6 and tPA were similar to those of F 1 + 2, and there was a correlation in the levels of F 1 + 2 and IL-6 (r = 0.54), tPA (0.41) and PIC (0.30) at each measurement time. PIC and TM, however, did not show statistically significant changes intra- and postoperatively, nor was there any correlation between F 1 + 2 and TM values. From these results, we conclude that inflammatory mediators and endothelial stimulation activated by surgical invasion may influence hypercoagulability. Vascular injury, however, did not act as the main coagulation factor during prolonged maxillofacial surgery.     

Expression of tissue factor is associated with clinical features and angiogenesis in prostate cancer

BACKGROUND: Tissue factor (TF), the main initiator of blood coagulation, is involved in cancer metastasis and progression. We examined the role of TF on prostate cancer. MATERIALS AND METHODS: Immunohistochemical analysis was performed using the anti-TF antibody. Intra-tumoral blood vessels were visualized by staining endothelial cells with CD34 antibody. We examined the expression of TF and the microvessel density (MVD) in 66 biopsy specimens of prostate cancer, in order to investigate the relationship between the expression of TF and the clinicopathology of prostate cancer. RESULTS: TF antigen was positive in 41 (62%) of the specimens. There were significant differences in TF expression according to the pretreatment prostate specific antigen (PSA) level (p = 0.0193) and bone metastasis (p = 0.0029). MVD was significantly related to bone metastasis (p = 0.0175). TF-positive carcinomas more frequently presented high MVD expressions (p = 0.017) than TF-negative tumors. CONCLUSION: These results suggest that increased angiogenesis associated with TF expression might cause the metastasis and progression of prostate cancer.     

New perspectives for tumor pathology provided by comparative genomic hybridization

 Comparative genomic hybridization (CGH) allows rapid screening for DNA copy number gains and losses across the entire genome. CGH analyses have revealed a number of common aberrations and characteristics associated with specific tumor cells or pathogeneses. Recurrent aberrations suggest that tumor-related gene(s) may be located in such regions. Furthermore, some specific aberrations may serve as novel diagnostic features. Quantitative chromosomal analyses based on CGH have also provided stimulating information associated with chromosomal instability, genetic pathways, telomerase activity status, and DNA ploidy and have yielded valuable insights into tumor pathology. This review focuses on scientific advances facilitated by this technique. Received: April 15, 2002     

A case of cerebellar ataxia showing severe dystonia masquerading as myoclonic jerky movements on arm extension]

A 43-year-old man was admitted to our hospital due to unstable walking, head tilting to the left and difficulty in extending his arm. He was quite healthy until the age of 20 years, when these symptoms appeared and progressed slowly afterward. Due to his unstable walking, he started to use a wheelchair when he was 39 years old. He had no family history of similar disease. On admission, neurological examination revealed spasmodic torticollis, ataxic speech and marked limb and truncal ataxia. Myoclonic jerky flexion of the forearm was induced when he raised and extended his forearm. He also showed mild hyperreflexia in the lower limbs without pathological reflexes. He had weakness and atrophy of the left supraspinatus, infraspinatus, deltoid and biceps brachii muscles and mild superficial sensory impairment in the left axillary nerve territory due to cervical spondylotic radiculopathy of the left C5 root. MRI of the brain demonstrated severe bilateral atrophy of the cerebellar hemispheres and vermis but minimal atrophy of the cerebrum and brainstem. Because surface electromyography revealed continuous discharge with phasic components in the biceps and wrist flexor muscles on extending the upper limbs, the jerky flexion movement of the forearm was considered to be primarily dystonia. Although no giant SEP was observed, a C-response was detected in the long-loop reflex in response to right median nerve stimulation. Nuclear examinations showed diffuse hypoperfusion and decreased glucose metabolism in the cerebellum. Based on these findings, we hypothesized that cerebellar dysfunction may have induced severe dystonic movement resembling myoclonus. We would like to name this complicated involuntary movement an "arm thrust". This is the first case to be reported of sporadic, chronic, progressive cerebellar ataxia accompanied by severe dystonic movement, especially on stretching the forearms, that mimics myoclonic movement.     

Spatial reference and standing posture during high-speed Coriolis stimulation

BACKGROUND: In a previous study, we found that sensation, gaze, and posture during Coriolis stimulation differ considerably between vision and nonvision conditions during rotations at 60 degrees x s(-1). To determine the validity of these findings at higher velocities, we compared standing postures during Coriolis stimulation up to 150 degrees x s(-1) between vision and nonvision conditions. METHODS: The 19 subjects underwent 5-min rotation tests at 50 to 150 degrees x s(-1). While standing on a force platform attached to a rotating device, each subject tilted his or her head and then returned it to upright, first with the eyes covered, then with eyes open. Six subjects were re-examined 5 d later after 4 consecutive days of 20-min rotations with their eyes open. We assessed success and failure to stand and recorded the center of pressure during rotation. RESULTS: Although success rates (number of successes/19) differed between vision and nonvision conditions at 50 degrees x s(-1) (94.7% vs. 57.9%), they steeply decreased as rotation velocity increased and showed no difference at 70 degrees x s(-1) and faster velocities. After the 4-d exposure, however, subjects could stand at higher velocities particularly under the vision condition. A patient with bilateral labyrinthine loss, being examined for reference, could stand at 110 degrees x s(-1) even with the eyes covered. CONCLUSIONS: Untrained subjects frequently fell during high-speed Coriolis stimulation, apparently because vision was insufficient to provide a spatial reference frame from the stationary surroundings. Following rotation training with their eyes open, subjects appeared more able to use the visual reference frame and falls were reduced.     

Unilateral proximal interruption of the pulmonary artery in adults: CT findings in eight patients

PURPOSE: The authors retrospectively reviewed CT findings of unilateral proximal interruption of the pulmonary artery in eight adults. METHODS: Patient age ranged from 23 to 65 years (mean, 44 years), and three men and five women (six left-side affected and two right-side affected) comprised the study group. High resolution CT was obtained in five patients. Associated anomalies of great vessels included five cases of right aortic arch and one tetralogy of Fallot. RESULTS: On the affected side, complete defects of pulmonary arteries were seen in all patients. CT revealed serrated pleural thickening in six patients (75%), subpleural parenchymal bands in five (63%), and mosaic attenuation in three (38%) on the affected lung. Dilatation of bronchial arteries in five patients (71%), internal thoracic arteries in four (57%), and intercostal arteries in three (43%) were also seen. As for other parenchymal changes, cystic bronchiectasis and honeycombing were seen in two (25%) respective cases. On the unaffected lung, mosaic attenuation was seen in four (50%) patients. CONCLUSIONS: The main manifestations of unilateral proximal interruption of the pulmonary artery were complete defects of pulmonary arteries, enlarged bronchial arteries, and formed pleural thickening or some parenchymal changes of the lung.     

Effects of nicorandil on myocardial function and metabolism in the post-ischaemic reperfused heart with or without inhalation anaesthetics

BACKGROUND: Nicorandil, which is an ATP-sensitive K channel opener, has been reported to protect the ischaemic myocardium. However, its interaction with inhalation anaesthetics on the ischaemic myocardium has not been well elucidated. So, we have investigated whether isoflurane or sevoflurane modify the effects of nicorandil on cardiac function and metabolism in the rat heart-lung preparation. METHODS: Animals were allocated to 4 groups as follows: Control group, no drug; Nic group, nicorandil; Nic+Iso group, nicorandil and isoflurane; Nic+Sev group, nicorandil and sevoflurane. Seven minutes after the start of perfusion, nicorandil was administered and 10 min after the start of perfusion, the heart was rendered globally ischaemic for 10 min, and then the heart was reperfused for 10 min. RESULTS: LVdP/dt max in the Nic group was higher than those in the other groups. Right atrial pressure in the Nic+Iso and Nic+Sev groups was significantly higher than in the Control and Nic groups. Myocardial ATP in the Nic group was higher than in the other groups. DHBA levels in the perfusate in the Nic and Nic+Iso groups were lower than those in the Control and Nic+Sev groups, but those in the Nic+Sev group were higher than those in the other groups. CONCLUSIONS: Nicorandil improved post-ischaemic cardiac function and preserved high-energy phosphates. However, these beneficial effects of nicorandil were abolished by the combination with isoflurane or sevoflurane. In addition, sevoflurane increased hydroxyl radical formation in the post-ischaemic reperfused heart.     

Biological characteristics in bladder cancer depend on the type of genetic instability.

PURPOSE: Malignant tumors show an inherent genetic instability that can be classified as microsatellite instability (MSI) or chromosomal instability (CIN). To elucidate the differences in biological characteristics of bladder cancer between the two types of genetic instability, the expression of the mismatch repair (MMR) proteins, Aurora-A and p53 proteins, the number of centrosomes, numerical aberrations of chromosomes and 20q13, and DNA ploidy were examined in 100 human urothelial carcinomas of the bladder. EXPERIMENTAL DESIGN: Expressions of the MLH1, MSH2, Aurora-A, and p53 proteins and the numbers of centrosomes were immunohistochemically assessed. Numerical aberrations of chromosomes 7, 9, 17, and 20q13 spots were evaluated by fluorescence in situ hybridization, and DNA ploidy was assessed by laser scanning cytometry. RESULTS: The expression levels of the MMR related-proteins decreased in 9 of 100 tumors. Tumors with low MLH1 or MSH2 expression (designated as MSI cancers) were not linked with centrosome amplification, Aurora-A overexpression, increased p53 immunoreactivity, 20q13 gain, DNA aneuploidy, and disease progression. MSI cancers showed a favorable prognosis. CIN cancers (49 cases), defined as tumors with a large intercellular variation in centromere copy numbers, were associated more frequently with centrosome amplification, Aurora-A overexpression, increased p53 immunoreactivity, and 20q13 gain than the others (51 cases). Tumors with disease progression were included in the CIN cancer group. CONCLUSIONS: The present observations suggest that there are differences in the biological characteristics of the two types of genetic instability.