Risk factors in past histories and familial episodes related to development of testicular germ cell tumor

BACKGROUND: A retrospective study was conducted to examine the host factors of 240 testicular germ cell tumor patients. This study was performed to address a new theory proposed by Skakkebaek called testicular dysgenesis syndrome which claims that cryptorchism, hypospadias, poor semen quality and testicular germ cell tumors are symptoms of an underlying testicular dysgenesis in uterus. METHODS: The past health histories and familial episodes of 240 testicular germ cell tumor patients were examined. The past health histories included cryptorchism, hypospadias, infertility, atrophic testis and inguinal hernia. RESULTS: Of the 240 patients, 13 (5.4%) had a history of cryptorchism or orchidopexy. Two (0.8%) showed existence of hypospadias or had experienced urethroplasty. Among 129 married couples, 104 (80.6%) couples were fertile. Three (1.3%) patients developed testicular tumors after they were diagnosed as infertile or came to the hospital with the complaints of infertility. Four (1.7%) had contralateral atrophic testis. 19 (7.9%) had experienced inguinal herniorrhaphy before age 15. Three (1.3%) had testicular germ cell tumor patients among their family or relatives. CONCLUSIONS: The testicular germ cell tumor patients showed a considerable incidence of complications such as cryptorchism, hypospadias and incomplete closure of processus vaginalis. Cryptorchism, perinatal factors and familial factors could be risks for developing testicular germ cell tumors.     

Developmental Changes of Amniotic Fluid Alpha-Fetoprotein Subtractions in Early Gestation

ABSTRACT: Using both concanavalin A crossed-line affinity immunoelectrophoresis and lentil lectin crossed-line affinity immunoelectrophoresis, developmental changes of alpha-fetoprotein (AFP) subfractions were studied in 11 samples of human amniotic fluid obtained between 43 and 121 days of gestation. In the amniotic fluid at 43 or 48 days of gestation, only subfractions produced by the yolk sac were evident. The initial appearance of the subfractions produced by the fetal liver was first detected at 51 days of gestation. Percentages of liver-originated subfractions rose rapidly with gestational age and reached a level of 50% at 54 days of gestation. The subfractions produced by the yolk sac disappeared from the amniotic fluid at 121 days of gestation. These findings suggest that, in early gestation, the yolk sac is mainly responsible for the fetal AFP synthesis and that initiation of AFP production by the fetal liver takes place between 48 and 51 days of gestation. In the present study, attention was also given to the origin of four subfractions separated by the lentil lectin crossed-line affinity immunoelectrophoresis.     

Tension-free vaginal tape surgery for stress urinary incontinencne: A prospective multicentered study in Japan

AIM: To report the prospective multicentered study of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. METHODS: One hundred and fifty-one women with stress urinary incontinence were operated on by the TVT procedure and were followed up at 3, 12, and 24 months after surgery. Patients' age and body mass index (BMI) averaged 57 years and 23.9, respectively. Forty-nine women were classified as type I, 46 women type II and 56 women type III (McGuire's classification). Local anesthesia was used in the operations on 137 women (91%) and epidural or general anesthesia was used in 14 (9%). Surgical outcomes were analyzed with Kaplan-Meier survival curves. RESULTS: The subjective and objective cumulative cure rates 24 months later were 92% and 77%, respectively (P > 0.05). The TVT operation for women with type III (62%) resulted in a significantly lower cure rate compared to those with type I or with type II (83%) (P < 0.001). Post-operatively a urethral catheter was indwelt one day in 77 women (51%), two days in 14 (9%) and 3-7 days in 60 (40%). Surgical complications were encountered in 43 women (28%). The most frequent was bladder perforation in 24 women followed by postoperative difficulty in urination and de novo urgency. CONCLUSIONS: The TVT surgery was promising for the treatment of stress incontinence because of minimal surgical invasiveness and satisfactory surgical results. Women with type III incontinence resulted in fewer satisfactory outcomes than those with type I or II incontinence.     

Trazodone for aggression in an adolescent with hydrocephalus

Abstract A case of 19 year old male with hydrocephalus is reported whose aggressive self-injurious behaviors were resistant to conventional pharmacotherapy but successfully treated by trazodone. In addition to the self-injurious behaviors, this patient displayed withdrawal and eating refusal, which initially resulted in his admission to a psychiatric ward. Various conventional treatments with pharmacotherapy (e.g., tricyclic antidepressants, antipsychotics, anxiolytics and anticonvulsants) in combination with psychotherapy and family therapy proved not to be effective for 15 months. Neither was electroconvulsive therapy successful. Administration of trazodone for 5 months after tapering of the above agents improved his aggressive behaviors. A survey of previous cases with organic brain syndromes who had aggressive behaviors and responded well to trazodone revealed that most of the cases were aged individuals and that cases in adolescence are rare.     

Effects of endoscopic variceal sclerotherapy on azygos vein blood flow and systemic haemodynamics*

The present study was designed to determine the systemic haemodynamic effects of obliterating oesophageal varices by endoscopic sclerotherapy. We evaluated systemic and splanchnic haemodynamics before and after the first course of sclerotherapy in cirrhotic patients. The baseline cardiac index was significantly correlated with baseline azygos vein blood flow (r = 0.64; P< 0.01) and the azygos vein blood flow and cardiac index significantly decreased (-33% and -16%, respectively; P< 0.01) following sclerotherapy. The systemic vascular resistance index was also increased significantly (+20%; P<0.01) in these patients. Moreover, the per cent change in azygos vein blood flow was directly correlated with that of the cardiac index (r=0.51; P< 0.03). We conclude from these findings that the obliteration of portosystemic collaterals by sclerotherapy significantly reverses hyperdynamic circulation in such patients via a decrease in cardiac preload. The blood flow of the portosystemic shunt per se is a leading contributor to the hyperdynamic circulation observed in patients with well-developed portal systemic collateral vessels.     

Histopathological Features of Plasma Cell Dyscrasia with Polyneuropathy and Endocrine Disturbances, with Special Reference to Germinal Center Lesions

The biopsy and autopsy materials of 41 cases showing clinicalmanifestations consistent with those of plasma cell dyscrasiawith polyneuropathy and endocrine disturbances were studiedby light microscopy and immunohistochemistry. The results obtainedare as follows: 1) Lymph node swelling was generalized and thesize of the nodes varies up to that of a thumb tip. 2) Angiosclerosisin the germinal centers of swollen lymph nodes is one pathognomonicfeature in this disorder and was common to all the cases examinedand occurred in the early stage. 3) The other feature is monoclonalproliferation of plasma cells (plasmacytoma) occurring not onlyin the bone marrow (five biopsy cases, seven autopsy cases)but also in the lymph nodes (nine biopsy cases, four autopsycases). 4) If all the bone lesions detected roentgenologicallyare regarded as being due to monoclonal proliferation of plasmacells, it was demonstrated in 26 of 31 biopsy cases (84%) andin 14 of 16 autopsy cases (88%). This suggests that the plasmocytomaparticipates in the development of clinical manifestations ofthe disorder. 5) Besides the characteristic lesions in the lymphnodes, proliferation of small blood vessels and hemangioma-likelesions were found in the spleen, subcutaneous connective tissueand visceral adipose tissues, and hemangiomatous verrucae werealso seen in the skin. As to the pathogenesis of the vascularlesions, vasculitis may be suggested. 6) The his-tologic featuresin the other organs and tissues seem to be closely related tothe development of varied clinical manifestations and are representedby atrophy in the sural nerves, gastrocnemius muscles, and endocrineor reproductive organs.     

Marked retention of indocyanine green and sulfobromophthalein with chronic persistent hepatitis

A hepatitis B virus (HBV) carrier with marked retention of indocyanine green (ICG) and sulfobromophthalein (BSP) was admitted to our hospital for assessment of liver function. On admission, he was asymptomatic and blood chemistry tests showed normal values for transaminases and bilirubin. Serum hepatitis B surface antigen (HBsAg) and antibody to hepatitis B e antigen (anti-HBe) were positive. A history of drug abuse or alcoholism was denied. Dye excretion tests revealed marked retention of ICG (R₁₅= 70%) and BSP (R₄₅= 23%). Histopathological examination of a liver biopsy specimen obtained during laparoscopic observation showed chronic persistent hepatitis (CPH). Familial research of the patient failed to prove the existence of dye excretory defect in his siblings. Usual cases of CPH due to continuous HBV infection do not show such severe disturbance of organic anion transport. This pattern of the dye excretory defect with CPH has not been reported. Although the relationship between this dye excretory defect and HBV infection is unclear, the existence of the constitutional dye excretory defect due to abnormal organic anion transport in the liver might be considered.