Susceptibility gene for non-obstructive azoospermia in the HLA class II region: correlations with Y chromosome microdeletion and spermatogenesis

We previously reported an association between the human leukocyte antigen (HLA) haplotype DRB1*1302-DQB1*0604 in the HLA class II region and non-obstructive azoospermia in Japanese men. To identify possible associations between the HLA-DRB1*1302-DQB1*0604 allele in the HLA class II region and azoospermia factor (AZF) deletion in the Y chromosome, we performed genomic polymerase chain reaction (PCR) analysis of the AZF region. We then determined spermatogenic impairment (Johnsen score) in testicular biopsy specimens from patients with or without the DRB1*1302-DQB1*0604 haplotype. The AZF microdeletion rate in patients with this haplotype was 3.85%, compared with 11.8% in others (no correlation). However, Johnsen scores in patients with the DRB1*1302-DQB1*0604 haplotype were 3.13 +/- 1.34 (mean +/- SD), compared with 3.70 +/- 1.51 in others (p < 0.05). While the DRB1*1302-DQB1*0604 haplotype acts independently from Y chromosome deletion, the haplotype might either act directly, or be functionally related to an unknown autosomal gene. In either case, this haplotype showed association with severe spermatogenic impairment.     

Treatment of ischial pressure sores by means of sclerotherapy using absolute ethanol

The ischial region is a common site of pressure sore. The ischial pressure sore with a large subcutaneous bursa is resistant to conservative treatment and tends to require radical surgical treatment. In this article the authors describe their experience with a simple surgical treatment on 8 ischial pressure sores in 7 patients with subcutaneous bursa by means of sclerotherapy using absolute ethanol. This method involves causing the bursa to become scarred and closing it up by sterilizing, fixing, and denaturing by the pharmacologic effect of absolute ethanol instead of surgical excision of the bursa. This alternative method has a possibility of treating pressure sores as well as other fistulous diseases in various areas.     

Treatment of full-thickness skin defect with concomitant grafting of 6-fold extended mesh auto-skin and allogeneic cultured dermal substitute

The aim of this clinical study was to evaluate an allogeneic cultured dermal substitute (CDS) as a biological dressing for highly extended mesh auto-skin grafting. The subjects were five patients with extensive deep burn wounds. Allogeneic CDS was prepared by seeding fibroblasts on a spongy matrix of hyaluronic acid and atelo-collagen. Six-fold extended auto-skin graft was applied to the debrided wound, on which allogeneic CDS was placed. A conventional ointment-gauze dressing was used to protect the CDS. The CDS was applied repeatedly at intervals of 5-7 days. In all cases, the wounds were closed by successful take of mesh auto-skin graft and prompt epithelization from the grafted skin. The skin on the grafted area had a cicatrix appearance, but was soft and thin, maintaining good quality. The application of 6-fold extended auto-skin graft in conjunction with allogeneic CDS is an effective method for treatment of extensive severe burn wounds.     

Clinical evaluation of transrectal power Doppler imaging in the detection of prostate cancer

To evaluate the clinical usefulness of power Doppler imaging (PDI), we compared this method to gray-scale transrectal ultrasound (TRUS) in the detection of prostate cancer. A total of 101 men with abnormally high serum prostate specific antigen (PSA) levels and/or abnormal digital rectal examination (DRE) findings were assessed using TRUS and PDI. Random systematic sextant and bilateral far lateral prostate biopsies were performed in all cases. In addition, when TRUS revealed a hypoechoic lesion or PDI revealed a hypervascular lesion (HVL), these lesions were directly biopsied. Of the 101 patients, 48 (47.5%), 42 (41.5%) and 42 (41.5%) were suspicious of having prostate cancer by DRE, TRUS and PDI, respectively. Prostate needle biopsy revealed prostate cancer in 39 patients (38.6%) and benign prostatic diseases in 62 patients (61.4%). If prostate needle biopsy was avoided when PDI was negative, then PDI eliminated the need for biopsy in 59 of the 101 patients (rate of biopsy procedures saved: 58.4%) and missed only 8 (13.6%) prostate cancers. Moreover, in 63 patients with intermediate PSA (3-10 ng/ml), the rate of biopsy procedures saved by DRE, TRUS, and PDI was 60.3%, 65.1%, and 68.3%, respectively, and the rate of cancers missed was 26.3%, 19.5%, and 14.0%, respectively. In a total of 826 specimens of TRUS-guided prostate biopsy, 126 (15.3%) specimens had adenocarcinoma. Site by site based analysis of the present series revealed 34.1% of prostate cancer sites were isoechoic and hypervascular. On a site by site basis, PDI had better sensitivity, specificity, positive predictive value and negative predictive value than TRUS. In 48 patients without abnormal DRE findings, on a site by site basis, the sensitivities of TRUS and PDI were 22.9% and 34.4%, respectively. Gleason score was associated with a positive rate of PDI on both a patient basis and site by site basis. From these results, on a patient basis, we conclude that PDI was helpful in the indication for prostate biopsy for all patients or patients with intermediate PSA level. On a site by site basis, PDI may be able to select prostate cancer sites at biopsy, in particular in patients without abnormal DRE findings.     

Currarino triad: a case report

The authors report a case of Currarino triad with a combination of anterior sacral meningocele and mature teratoma, sacral body deformity, anorectal stenosis, and tethered cord. A newborn girl suffered from vomiting, abdominal distension and constipation. Initially, a diverting colostomy was performed at the age of one month. 7 months later, at the age of 8 months, we performed posterior sagittal anorectoplasty (PSARP): As a result, extirpation of teratoma, excision of meningocele, untethering of the spinal cord, and anorectoplasty were achieved simultaneously without complication. We suggest the use of an MRI to specify the presence of anosacral and spinal cord anomalies in patients with intractable constipation and we recommend combined pediatric and neurosurgical assessment and management for all cases of Currarino triad.     

Acute Korsakoff syndrome following mammillothalamic tract infarction

There are limited case reports of structural lesions causing Korsakoff syndrome. This report describes acute Korsakoff syndrome following localized, bilateral infarction of the mammillothalamic tracts (MTTs). Axial T2-weighted imaging revealed the lesions at the lateral wall level of the third ventricle and diffusion-weighted imaging confirmed that the left lesion was new and the right old. Korsakoff syndrome persisted 6 months after the onset. This case suggests that bilateral MTT dysfunction can lead to Korsakoff syndrome.     

Conventional open surgery versus percutaneous catheter drainage in the treatment of cervical necrotizing fasciitis and descending necrotizing mediastinitis

OBJECTIVE: The purpose of our study was to determine the clinical usefulness of percutaneous catheter drainage compared with conventional surgical drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis. SUBJECTS AND METHODS. Thirty-one patients with cervical necrotizing fasciitis and descending necrotizing mediastinitis were included. Twenty consecutive patients were treated by percutaneous catheter drainage. Catheters were introduced into the infected space from the neck, under the guidance of sonography and X-ray fluoroscopy. The results of the treatment were compared with those of 11 patients treated previously by surgical drainage. RESULTS: In the catheter group, no patient required supplementary surgical drainage. Mortality was 0% in both groups. Comparison of length of stay in the ICU, serial changes in C-reactive protein levels, duration of antibiotic therapy, and duration of mechanical ventilation all showed no statistically significant difference between groups. Secondary infection of the wound and positive culture of antibiotic-resistant bacteria were observed less frequently in the catheter group than in the open surgical group. The total use of plasma infusion and analgesics was significantly less in the catheter group than in the surgery group. Oral feeding was started significantly earlier in the catheter group than in the surgery group. CONCLUSION: Percutaneous catheter drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis was less invasive than conventional surgical drainage but produced a similar outcome.     

False-positive and true-negative hilar and mediastinal lymph nodes on FDG-PET —Radiological-pathological correlation—

OBJECTIVE: To compare histological findings of FDG-PET false-positive and true-negative hilar and mediastinal lymph nodes. METHODS: Sixty-seven lymphnode areas in 11 patients who were diagnosed to have N3 lymph nodes by FDG-PET and underwent surgery were histologically examined, and the histopathological findings in false-positive and true-negative lymph nodes were compared. Lymph nodes with higher accumulation of FDG than the surrounding mediastinum level were judged as positive. On histological sections, proportions of macrophages and lymphocytes, amount of coal dust deposit, presence of silicotic nodules, long- and short-axes of the largest node, and volume of macrophages and lymphocytes were evaluated. Correlations between the above-mentioned factors and FDG accumulation were evaluated. RESULTS: FDG uptake was not correlated with the proportion of macrophages and lymphocytes, coal dust amounts, or the presence of silicotic nodules. The long- and short-axes of the largest node in the false-positive areas were significantly longer than those in the true-negative areas (p = 0.01, and 0.001, respectively). Volumes of lymph nodes (mean +/- SD: 150 +/- 190 mm3) and macrophages (78 +/- 71 mm3) in false-positive areas were markedly larger than those in true-negative areas (68 +/- 87 mm3, p = 0.0009 and 34 +/- 54 mm3, p = 0.0001, respectively). The volume of lymphocytes was also larger in false-positive areas but less markedly. CONCLUSION: Our study suggested that false-positive results of FDG-PET in hilar and mediastinal lymph nodes were closely related to the size of lymph node and the volume of macrophages.