Testicular abscess: report of 2 cases

We report two cases of testicular abscess. The first case is in a 53-year-old man who had been suffering from diabetes mellitus. Because of cerebral infarction, he had been bedridden and a Foley catheter had been indwelt for a long period of time. The second case is in a 78-year-old man who had suffered from acute prostatitis six months earlier. In both cases, the chief complaints were high fever and painful scrotal swelling. At initial evaluation, ultrasonography revealed that the affected testes were swollen without abscess formation and an ipsilateral epididymal swelling was demonstrated in the second case but not in the first case. The urine bacterial culture (UBC) result was positive for Escherichia coli in first case and Pseudomonas aeruginosa in the second case. In both cases, fever and scrotal pain subsided after antibiotic chemotherapy, and inflammatory reactions on routine blood studies were normalized within 2 weeks. Nevertheless, the swollen testes did not sigunificantly reduce in size, and testicular abscess was suspected by magnetic resonance imaging (MRI). Orchiectomy was performed, and intratesticular abscess formations were confirmed macroscopically and microscopically. In each case, bacterial culture from the abscess was positive for the same bacterium as detected from the UBC. It is difficult to distinguish testicular abscess from acute epididymitis at the early stage because of similarities on symptoms or signs between the two. If testicular swelling lasts after appropriate chemotherapy, we believe that attention should be directed to testicular abscess, which needs orchiectomy to obtain a complete cure and MRI is useful in its diagnosis.     

Complete neurological recovery in a patient with decerebrate rigidity following cardiac arrest from acute airway obstruction by advanced laryngeal cancer

A 59-year-old man presented with severe dyspnea caused by advanced laryngeal cancer. As he had disregarded the dyspnea for a month, we did not have enough information about the extent of the tumor. The pulse oximeter showed 88% with oxygen inhalation. Because of severe dyspnea, he could not maintain supine position. Fiberoptic laryngoscopy showed tumor bulk obstructing airway directly. In the operating room, at first, a cricothyroid membrane puncture was attempted under local anesthesia but the procedure was abandoned when the patient became hypoxic and unconscious. Immediately tracheostomy and cardiopulmonary resuscitation were performed. Tumor bulk had displaced the trachea and surrounding structures, making a tracheostomy difficult. Nine min after loss of consciousness, a secure airway was obtained. However, he was still unconscious and developed characteristic decerebrate rigidity. Therefore the patient was treated with infusion of thiamylal and free radical scavenger and mild hypothermia therapy (bladder temperature 34 degrees C). On the fifth day of this treatment, after rewarming and discontinuation of thiamylal, the patient responded to command. He recovered with no neurological deficits. This case suggests that combined treatment with barbiturate, free radical scavenger, and mild hypothermia therapy is effective to minimize ischemic brain damage after cardiopulmonary resuscitation.     

Effect of postoperative chemotherapy on the serum alpha-fetoprotein level in hepatoblastoma

Purpose

It is generally accepted that postoperative chemotherapy does not affect the serum alpha-fetoprotein (AFP) level. The authors report on 3 patients who supposedly showed chemotherapy-related changes in their AFP levels after operation.

Methods

This study included 3 patients with hepatoblastoma (1 case of PRETEXT III and 2 cases of PRETEXT IV).

Results

One patient with PRETEXT III underwent a complete tumor resection, and the postoperative AFP level decreased until it reached the normal range. However, he consistently exhibited a transient, 2- to 3-fold increase in the AFP after each course of chemotherapy for 3 courses. The chemotherapy regimen had to be stopped because of drug-induced encephalopathy, but he has been followed up for 5 years without any evidence of recurrence, and his AFP level has also remained stable and in the normal range. Two patients with PRETEXT IV, who underwent a curative tumor resection, also showed similar chemotherapy-related changes in AFP levels. Both of these cases were observed only after the administration of routine postoperative chemotherapy instead of administering further high-dose chemotherapy. The AFP level remained stable for 17 months and 7 months after the cessation of chemotherapy in 2 cases, respectively.

Conclusions

Regarding the postoperative chemotherapy of hepatoblastoma, we have to pay close attention to both the AFP status during chemotherapy as well as the absolute AFP level.     

Ca2+ sensitization in contraction of human bladder smooth muscle

PURPOSE: The role of Ca2+ sensitization in the contraction of human bladder urinary smooth muscle (UBSM) was investigated. MATERIALS AND METHODS: Simultaneous measurements of intracellular Ca2+ concentration ([Ca2+]i) and tension in fura-2 loaded intact strips and receptor coupled strips permeabilized with alpha-toxin were applied. Protein expressions was confirmed by Western blot analysis. RESULTS: In intact fura-2 loaded strips 1 microM carbachol (CCh) induced a greater contraction and a lower [Ca2+]i elevation than that induced by 60 mM K depolarization. In alpha-toxin permeabilized strips 1 microM CCh induced contraction at constant [Ca2+]i and produced a leftward shift in the [Ca2+]i-tension relationship. RhoA, Rho-associated kinase (ROCK) I, ROCK II and CPI-17 proteins were expressed in human UBSM. In intact fura-2 loaded strips the application of 3 microM Y-27632, a ROCK inhibitor, or 3 microM bisindolylmaleimide I (GF109203X), a protein kinase C inhibitor, during the sustained phase of contraction induced by 1 microM CCh induced relaxation without changing [Ca2+]i. In alpha-toxin permeabilized strips the application of 3 microM Y-27632 or 3 microM GF109203X during the sustained contraction induced by 0.3 microM Ca plus 10 microM guanosine triphosphate and 1 microM CCh induced relaxation at constant [Ca2+]i. CONCLUSIONS: These results indicate that in human UBSM CCh induces contraction, not only by increasing [Ca2+]i, but also by increasing the Ca2+ sensitivity of the contractile apparatus in a ROCK and protein kinase C dependent manner. Antagonism of Ca2+ sensitization pathways may represent an alternative target in the treatment of overactive bladder.     

Conversion of atrial fibrillation to sinus rhythm during landiolol infusion

A 71-year-old woman with a history of persistent atrial fibrillation underwent clipping of a ruptured cerebral artery aneurysm. During the surgery her cardiac rhythm was atrial fibrillation and the ventricular rate increased to 130 beats·min^–1. Administration of landiolol was started with 1-min loading infusion at 0.125mg·kg^–1·min^–1 and continuous infusion at 0.04mg·kg^–1·min^–1, which was effective in controlling the ventricular rate without causing hypotension. Approximately 120min after the landiolol infusion was started, the atrial fibrillation was converted to sinus rhythm. Her sinus rhythm was maintained until she left the operating room, even after discontinuation of landiolol.     

Spontaneous healing process of a supraspinatus tendon tear in rabbits

Introduction The rotator cuff has a characteristic structure, in that one surface faces articular cartilage and another faces bursa. This structure may produce differences in the healing process between the rotator cuff and other tendons. We investigated the spontaneous healing process of a surgically created supraspinatus tendon tear in rabbits.Materials and methods A transverse, full-thickness tear of the supraspinatus tendon was created and its healing examined.Results A tear of 12 mm was not repaired within 3 weeks. With a tear of 5 mm, reparative tissue gradually encroached into the defect from the bursal side, and the tear united from the bursal side to the articular side by 12 weeks. The healing rates (width of reparative tissue/width of the tendon×100%) were 32.2%, 52.4%, 58.0%, 88.9%, and 93.8% at 1, 2, 3, 6, and 12 weeks, respectively. The reparative tissue had continuity to the epitenon of the bursal side. Immunohistochemical study showed that at week 1, type III collagen was detected in the reparative tissue and the cutting ends, and the expression gradually decreased. On the other hand, the expression of type I collagen in the reparative tissue was weak at week 1 and increased until week 3. PCNA-positive cells were observed in the reparative tissue.Conclusion These results show that the origin of the reparative tissue is the epitenon, and from the bursal side rather than the articular side. This model is very useful for the investigation of the remodeling process of an acute rotator cuff tear.     

Denervation and Reinnervation of the Heart After Aortic Surgery,Estimated by <Superscript>123</Superscript>I-Metaiodobenzylguanidine Scintigraphy

Purpose To investigate whether sympathetic nerve injury occurs during aortic surgery and how reinnervation takes place afterward.Methods Imaging with ¹²³I-metaiodobenzylguanidine (MIBG) was performed in 12 patients (aortic group) who underwent aortic surgery (ascending replacement 3, ascending-arch replacement 9) before and 3 weeks after surgery. In 8 of 12 patients, MIBG scintigraphy was performed 1 and 2 years after surgery. Twelve patients (control group) who underwent open-heart surgery (mitral valve repair: 11; tricuspid valve replacement: 1) were studied using MIBG scintigraphy. The heart-to-mediastinum (H/M) activity ratio was obtained from planar images. The myocardial single-photon-emission computed tomography image was divided into five segments and the regional tracer uptake was scored from 0 = absent to 3 = normal uptake.Results No significant difference in the H/M ratio in either early and delayed planar scans was observed between both groups before surgery. The H/M ratios significantly decreased 3 weeks after surgery in the aortic group, whereas there was no significant change in the control group. The H/M ratio did not recover to the preoperative level within 2 years. In these 8 patients, the regional uptake of MIBG improved in the anterior and septal regions 1 year after surgery.Conclusion During ascending or ascending-arch replacement, the sympathetic nerve was globally denervated and slight reinnervation was observed within 2 years. The anterior and septal regions showed a rapid reinnervation, whereas other regions did not.     

Neurologic and histopathologic evaluation after high-volume intrathecal amitriptyline

BACKGROUND AND OBJECTIVES: Accumulating evidence indicates that amitriptyline decreases pain sensation when administered orally, intraperitoneally, or for sciatic nerve block. Previous reports of intrathecal administration of amitriptyline have yielded inconsistent results. The failure of amitriptyline to provide antinociception may partly be related to its high logP (octanol-water partition coefficient) and consequent poor spread within the cerebrospinal fluid. We evaluated spinal block after various concentrations of amitriptyline administered intrathecally in a fixed high volume. METHODS: We administered 100 microL of 5, 10, 15.9 (0.5%), 25, 50, or 100 mmol/L amitriptyline hydrochloride solution or 100 microL of 15.4 mmol/L (0.5%) bupivacaine hydrochloride solution intrathecally to rats. The neurologic deficit was evaluated by antinociceptive, motor, and proprioceptive responses, and the spinal cord was examined for histopathologic changes. RESULTS: Doses of 100 microL amitriptyline at 15.9 mmol/L (0.5%) and 25 mmol/L produced longer complete nerve block than did bupivacaine at 15.4 mmol/L (0.5%); 5 and 10 mmol/L amitriptyline produced only partial nerve block. However, with 100 microL intrathecal amitriptyline at 50 and 100 mmol/L, many rats did not fully recover from spinal block. Severe axonal degeneration, myelin breakdown, and replacement of neuronal structures by vacuoles were seen in the spinal root section of animals injected with concentrations higher than 25 mmol/L amitriptyline. CONCLUSIONS: At lower doses, intrathecal injection of high volumes of amitriptyline results in long-acting spinal block. At higher doses, intrathecal amitriptyline results in irreversible neurologic deficit. Therefore, we do not recommend the use of intrathecal amitriptyline because of a very low therapeutic index.     

New simple method for small, dense LDL: development of a new quantification method and clinical significance

Small, dense LDL (S LDL) is regarded as a significant risk factor for coronary heart disease (CHD) and has also been reported its high appearance in type 2 diabetic patients. Although ultracentrifugation and electrophoresis based methods are currently used for the measurement of S LDL, such methods are either too laborious or expensive for clinical use. We have developed a simple method for quantification of S LDL. The new method consists of two steps; first to filter out large buoyant LDL and other apoB-containing lipoproteins by forming aggregates of these unintended lipoproteins with a heparin-manganese based reagent; and second to measure S LDL-cholesterol (S LDL-C) in the penetrate solution, the mixture of HDL and S LDL, on automated general chemistry analyzers. Comparison with the ultracentrifugation method yielded a correlation coefficient of 0.900 and an equation of y = 1.090x-1.8 (n = 146). Positive correlation was observed with total LDL-C level and also with triglyceride level (r = 0.782 and r = 0.526, respectively) while negative correlation was observed with LDL particle size (r = 0.658). As for the study with various types of hyperlipidemia sample, the highest level of S LDL-C was observed in combined hyperlipidemia patients. Patients with CHD had higher S LDL-C than control group (45.2 +/- 22.1 in the CHD vs. 36.7 +/- 16.9 in the control), however no difference was seen in total LDL-C level between the two groups (117.6 +/- 35.0 in the CHD vs. 115.7 +/- 30.1 in the control). Patients with type 2 diabetes also showed higher S LDL-C (54.0 +/- 22.7). S LDL-C/LDL-C ratios were also significantly higher in CHD patients and in type 2 diabetes patients than the control group (39.9 +/- 16.7 in the CHD, 37.6 +/- 13.0 in the type 2 diabetes and 31.0 +/- 9.9 in the control). Our findings suggest that this method can measure S LDL reliably with a simple procedure and that the analysis of S LDL-C can give a better index for the risk assessment of CHD than total LDL-C.