Transient Acantholytic Dermatosis with Involvement of Oral Mucosa

Histologic, immunologic and electron microscopic studies were performed in a patient with transient acantholytic dermatosis which involved oral mucosa. Hitologic and electron microscopic findings were almost identical in both cutaneous and mucous membrane lesions, and these were similar to pemphigus vulgaris; suprabasilar separation with acantholytic cells. Desmosome-desmosome complexes were separated without disruption of cell membranes and cytoplasmic structures were well-preserved without dyskeratosis. Lamina lucida, however, was often separated in mucous membrane lesions, in contrast to the normal lamina lucida in cutaneous lesions of such cases or in pemphigus vulgaris. Direct and indirect immunofluorescence studies for pemphigus were repeatedly negative. This study shows that transient acantholytic dermatosis may involve mucous membrane and may resemble pemphigus vulgaris histologically and ultrastructurally except for the widened lamina lucida of the mucous membrane.     

CURRENT AND FUTURE TRENDS IN INTERVENTIONAL THERAPY FOR BENIGN PROSTATIC HYPERPLASIA IN JAPAN

Purpose

Procedures of Japanese urologists of interventional therapy for benign prostatic hyperplasia (BPH) should be defined for resource economy and policy establishment.

Materials and Methods

A questionnaire was mailed to the urology departments of 80 medical schools in Japan for clarification of surgical procedures presently in use for treating bladder outlet obstruction due to BPH. Prospects for the next 5 years (year 2002) were also requested.

Results

We received 76 questionnaire responses from medical school urology facilities (95%) by the end of January 1997. Standard transurethral resection of the prostate gland is and will continue to be the most common surgical procedure. Open adenectomy is the first choice for large glands but may be replaced by other interventional procedures. Laser prostatectomy and transurethral electrovaporization will be used more often for treating all severities of BPH.

Conclusions

Even with increasing interest in new techniques, transurethral resection of the prostate will continue to serve as the standard therapy for BPH during the next 5 years. Transurethral electrovaporization may become established in the near future.     

Laparoscopic removal of a retroperitoneal extralobar pulmonary sequestration in an adult

A 41-year-old male patient presented with dull left flank pain. A computed tomography (CT) showed a subdiaphragmatic retroperitoneal extra-adrenal mass. A magnetic resonance image demonstrated it was hypointense on T1 weighted and hyperintense on T2. Serum analyses for adrenal hormones revealed no abnormality. [I131]metaiodo-benzylguanidene scintigraphy showed no abnormal uptake. The patient underwent laparoscopic removal to manage the symptoms and to make a pathological diagnosis, which was an extralobar pulmonary sequestration. Another congenital lung malformation was not detected on chest CT scan. The symptom was relieved postoperatively.     

Neonatal abdominal wall urinoma due to rupture of anterior urethral diverticulum

An anterior urethral valve with diverticulum is an uncommon cause of congenital urethral obstruction and urinary extravasation compared with a posterior urethral valve. We report a neonate presenting with an abdominal wall urinoma caused by rupture of an anterior urethral diverticulum. Urine drainage via urethral catheter was effective to resolve the abdominal urinoma. Voiding cystourethrogram performed 6 months after an endoscopic incision of the distal margin of the diverticulum revealed a normal urethra with smooth voiding. To our knowledge, no similar case has been reported previously.     

Oestrogen receptor‐β1 but not oestrogen receptor‐βcx is of prognostic value in apocrine carcinoma of the breast

Apocrine carcinoma of the breast, which frequently expresses oestrogen receptor‐β (ER‐β) in the absence of ER‐α and only infrequently is treated endocrinologically, gives an opportunity to investigate the clinicopathological role of ER‐β in breast cancer independent of ER‐α expression or tamoxifen treatment. Several isotypes of ER‐β, ER‐β1–5 etc., have been identified thus far; however, the clinicopathological importance of each ER‐β isotype in breast cancer is still uncertain. Here we aimed to clarify the clinicopathological importance of ER‐β1 and ER‐βcx (ER‐β2) in apocrine carcinomas, immunohistochemically examining expressions of ER‐β1 and ER‐βcx in 47 apocrine carcinomas. Positivity for ER‐β1 and ER‐βcx was observed in 41 (87%) and 18 (38%) of 47 cases, respectively. ER‐β1 positivity was related to smaller tumor size (P=0.0359), lower histological grade (P=0.0322), and higher disease‐free survival (P<0.0001), whereas ER‐βcx status was related to none of these parameters. ER‐β1 positivity was also associated with favorable clinical outcome in 24 so‐called triple‐negative (ER‐α‐negative/PR‐negative/HER2‐negative) apocrine carcinomas. ER‐β1 itself, independent of ER‐α expression and tamoxifen treatment, seems to have a tumor‐suppressive effect, at least in apocrine carcinomas. Further study of ER‐β1 is desired to optimize breast cancer treatment.     

5-year interval change in voiding function of orthotopic ileal neobladder

AIM: We report the 5-year interval change in voiding function of orthotopic ileal neobladder. METHODS: Voiding function was evaluated at two points with an interval of 5 years in 49 patients with orthotopic ileal neobladder. The first and second surveys were performed in May, 1998 (1998 survey) and in April 2003 (2003 survey), respectively. Median age at operation was 67 years, ranging 47-77. Median follow-up times at the first and the second surveys were 19.5 months (range, 3-87) and 67.5 months (range, 62-145), respectively. RESULTS: There was no significant change in daytime continence status between the 1998 and 2003 surveys. More than 95% never or only occasionally suffered daytime incontinence in the two surveys. On the other hand, 15 (34.1%) and 14 (31.8%), respectively, experienced night-time incontinence, despite regular voiding during the night. When voiding patterns were analysed, 11 patients (23.4%) sometimes or often performed catheterization because of difficulty in urinating or incomplete emptying of the neobladder in the 1998 survey. Three patients (6.4%) were unable to void and required regular catheterization. In the 2003 survey, however, such poor voiders increased to nine (19.1%), although the difference was not significant. During the study period of 5 years, there was no change in renal function. CONCLUSIONS: Continence status, either at daytime or at nighttime, was stable during the study period. The number of the patients who needed regular catheterization tended to increase, suggesting deterioration of voiding function with time. Careful long-term follow up is warranted.     

Relevance of postcatheter removal incontinence to postoperative urinary function after radical prostatectomy

AIM: We examined whether postoperative urinary function after radical prostatectomy is associated with immediate incontinence just after catheter removal. PATIENTS AND METHODS: The current study included 80 patients with clinically localized prostate cancer, who underwent radical retropubic prostatectomy between January 2002 and May 2004. The amount of immediate incontinence was measured with a 24-h pad test just after catheter removal. The patients were categorized into the three groups based on the stratified grade of immediate urinary incontinence: groups I (0 g; 47 patients), II (1-99 g; 23 patients) and III (100 g and above; 10 patients), respectively. Urinary function and bother were assessed by a self-administered questionnaire using the University of California Los Angeles, Prostate Cancer Index at baseline, and at 3, 6 and 12 months postoperatively. The differences in scores of urinary function, bother and clinicopathological parameters were assessed in the three groups with one-way analysis of variance. RESULTS: No significant difference was observed in the clinicopathological parameters in the three groups. Preoperatively significant difference of urinary function scores was not evident and that of urinary bother scores was not observed in the three groups. Postoperatively urinary function scores were significantly different throughout the postoperative periods investigated, whereas difference in urinary bother scores observed at 3 months tended to disappear with time. CONCLUSION: Postcatheter removal incontinence might be related to postoperative urinary function after radical prostatectomy, although further investigation is necessary regarding the criteria for categorization because of a small number of the patients.     

Epithelioid granulomas in chronic hepatitis C: A transient pathological feature

Multiple hepatic granulomas in chronic hepatitis C patients treated with alpha interferon were recently observed. To assess the presence of hepatic granulomas in chronic hepatitis C, and to determine whether their presence is related to interferon therapy or primarily related to chronic hepatitis C viral (HCV) infection, 446 liver biopsy specimens from 239 Japanese patients with chronic hepatitis C were reviewed. Well-formed non-caseating epithelioid granulomas were found in five (1.1%) of 446 liver biopsy specimens from five (2.0%) of 239 patients. All five patients had been followed up for 1 to 3 years, having between one and six liver biopsy specimens taken at intervals of 6 months to 1 year. Four of these five patients received alpha interferon therapy during the follow-up period. Hepatic granulomas were found in one of the pretherapy liver biopsy specimens in four patients and in one of the post-therapy specimens in one patient. Extensive investigation of the aetiology of hepatic granulomas yielded no conclusive findings. The presence of hepatic granulomas could not be demonstrated in follow-up liver biopsy specimens taken from the four patients who had undergone alpha interferon therapy. These findings suggest that hepatic granulomas may appear as an expression of non-specific reaction in HCV-related chronic hepatitis, and are not related to alpha interferon therapy.