Gastric diverticulum preoperatively diagnosed as one of two left adrenal adenomas

A 47-year-old man was diagnosed with primary aldosteronism due to two left adrenal adenomas, suggested on computed tomography (CT) to be located at the upper and lower adrenal portion. However, adosterol scintigraphy revealed negligible uptake at the upper portion of the left adrenal. Laparoscopic left adrenalectomy was performed, but macroscopic examination of the specimen revealed only one adrenal tumor. Continued surgical exploration detected another mass between the spleen and the stomach, which was demonstrated to be continuous with the stomach and was eventually diagnosed as a gastric diverticulum. Postoperatively, aldosteronism resolved and repeat CT revealed staining of the adrenal pseudotumor when oral contrast was administered. Since organs located near the adrenals can simulate adrenal tumors, caution must be exercised in interpreting suprarenal masses on CT. To our knowledge, this is the first reported case of concurrent pseudotumor and true tumor of the ipsilateral adrenal.     

Clinical features of testicular tumors in children

AIM: Testicular tumors are not common pediatric solid tumors, especially in Asian children. There have been few reviews of cases in Japan to date. We present the clinical features of 14 pediatric testicular tumor patients. METHODS: Clinical features of 14 testicular tumor patients, such as chief complaints, age at diagnosis, pathology, stages, treatments and prognosis, were examined from medical records. Two patients had their semen tested at adolescence. RESULTS: Of the 14 prepubescent patients, 12 (85.7%) patients were diagnosed before 3 years of age. Ten cases (71.4%) were diagnosed as yolk sac tumors, three (21.4%) as mature teratomas and one case as an epidermoid cyst. Nine cases (90.0%) among the 10 cases of yolk sac tumor were diagnosed as stage I and one case was stage IV. One stage I yolk sac tumor patient developed lung metastasis later. Eventually, two yolk sac tumor patients died, despite chemotherapy. While all the cases with a diagnosis before 2 years of age survived, 67% (2/3) of cases with a diagnosis after the age of 2 died of tumors. Semen analysis in two patients showed normospermia. CONCLUSION: In the present study, the most common testicular tumors were yolk sac tumors and the patients diagnosed before 2 years of age showed favorable results. Age could be a relapse risk factor in yolk sac tumors. Guidelines for handling testicular tumors in children is not yet well established in Japan. An organized system seems necessary to gather and accumulate the results of the cases in Japan in order to develop better guidelines for treatment.     

Correlation between α1–Adrenoceptors in Biopsy Specimens and Endoscopic Color Changes of Human Gastric Ulcer

α₁–Adrenoceptors were measured in the scar tissue (U) and marginal normal mucosa (C) of human gastric ulcers by radio-binding assay using [³H]-prazosin as the ligand. The specific radioactivity binding was calculated for the membrane-rich fractions of the U and C regions along with U/C ratio, and the relationship between the scar color tone and α–adrenoceptor binding levels was studied by conventional endoscopy and pharmacoendoscopy The U/C ratio for red scars (mean: 92.2%) increased as redness decreased. White scars had a mean U/C ratio of 135.6%. For pharmacoendoscopic classes P₁ and P₂, which remained red after spraying epinephrine onto the scar, the mean U/C ratio was 86.8%. For the P₃ class, which turned pale after the application of epinephrine spray, the mean U/C ratio was 172.0%. The recurrence of peptic ulcers is more frequent when red scars ocAcur, assessed by conventional endoscopy, in the P₁ and₂ classes, evaluated by pharmacoendoscopy, than in white scars (P₃ class). As the α₁–adrenoceptor binding of [³H]-prazosin appears to be proportional to the maturity of vasculature tissue, the present data suggest this latter factor plays a key role in the recurrence of gastric ulcers and that pharmacoendoscopy allows for a more accurate prognosis of ulcer relapse than conventional endoscopy     

Multiple glomus tumours: successful treatment with electron beam irradiation

A case is reported of a 23-year-old male with multiple glomus tumours that showed marked involution after he had electron beam therapy.     

Frequency- and Time-Domain Analysis of P Wave in Patients with Paroxysmal Atrial Fibrillation

We investigated the usefulness of the time- and frequency-domain analysis of the P wave triggered signal-averaged ECG (P-SAECG) for detecting patients with paroxysmal atrial fibrillation (Paf). In previous studies, the usefulness of the time domain of the P-SAECG to detect patients with Paf was described but that of the frequency domain is unknown. We analyzed the P-SAECG in the time and frequency domain in 23 patients with Paf and 19 controls. The 32-unipolar chest lead ECGs and the standard bipolar limb lead ECGs were obtained. The time-domain analysis showed that the filtered P duration (fPd) was significantly longer (P < 0.01) in patients with Paf than controls: the predictive accuracy of Paf with fPd > 120 ms was 69%. The frequency domain analysis showed that the area ratio of power spectrum area of 0–20 Hz to 20–100 Hz (AR20) was significantly higher (P < 0.01) and the magnitude ratio at 30 Hz (%Mag.30) calculated by dividing the magnitude at 30 Hz by the maximal magnitude was significantly (P < 0.01) lower in patients with Paf than controls in the left lateral chest leads. The predictive accuracy of Paf with AR20 ≥ 1.5 and that with %Mag.30 < 40% was 83% and 73%, respectively. Our results indicate that the frequency-domain analysis of P waves in lateral leads is useful as is the time-domain analysis to detect patients with Paf. The AR20 ≥ 1.5 and %Mag.30 < 40% provides accurate predictability of Paf.     

Nocturnal enuresis and overactive bladder in children: An epidemiological study

AIMS: To investigate the prevalence and characteristics of nocturnal enuresis (NE) and to examine the prevalence of overactive bladder (OAB) symptoms in primary schoolchildren. METHODS: After conducting an anonymous questionnaire survey about voiding habits and bowel habits in primary schoolchildren, a total of 6917 schoolchildren belonging to 11 primary schools were randomly enrolled in the survey. According to the International Continence Society, we defined NE as any involuntary loss of urine during sleep, occurring more frequently than once per month. Children with NE were subdivided into two groups, monosymptomatic NE (MNE) and enuretic syndrome (ES). To evaluate the characteristic differences of MNE and ES, we assessed the relationships between NE and voiding habits, and episodes of cystitis and constipation. Overactive bladder was defined as increased daytime frequency and/or urge urinary incontinence, and its prevalence was investigated. RESULTS: The response rate to the questionnaire was 76.4%. The prevalence of NE was 5.9% and was inversely related to increasing age. Monosymptomatic NE comprised 59.4% of NE cases. The annual spontaneous resolution rate of MNE was higher than that of ES. Increased daytime frequency, a history of cystitis and infrequent bowel habits were not related to MNE, but were significantly related to ES. The prevalence of OAB was 17.8%. Children with a history of cystitis had a significantly higher rate of OAB than children without it. CONCLUSIONS: Overall, NE and OAB were detected in 5.9% and 17.8% of primary schoolchildren, respectively. The link between NE and OAB symptoms, urinary tract infections and constipation deserves more attention.