INFANTILE GRANULOMATOUS URACHAL ABSCESS WITH ACUTE LOCALIZED PERITONITIS AND APPENDICITIS

Infected urachal remnants in early childhood are occasionally seen. However, intraperitoneal penetration of an infected urachal remnant, resulting in acute peritonitis, is rare. We report a case of infantile granulomatous urachal abscess extending into the peritoneum and appendix. The diagnosis and treatment of urachal abscess in childhood are discussed.     

Desmoplastic ameloblastoma featuring basal cell ameloblastoma: a case report

The desmoplastic ameloblastoma is a histological variant of ameloblastoma. The neoplastic epithelial islands seen in desmoplastic ameloblastoma are small and ameloblastic cells are rare. Basal cell ameloblastoma is also a rare variant of ameloblastoma, in which the tumor is composed of more primitive cells and has even fewer features of peripheral palisading. This report describes the case of a 17-year-old female with an ameloblastoma in the right anterior maxilla. Orthopantomography and computed tomography showed a well-defined lesion in the right maxilla. A partial maxillectomy for tumor resection was performed under general anesthesia. Histologically, ameloblastic tumor cells were seen with dense collagenous stroma and the tumor cells showed primarily basal cell variants of ameloblastoma. After 7 years of follow-up, clinical and radiographic examinations have revealed no evidences of recurrence.     

The impact of radical prostatectomy on patient well-being: a prospective urodynamic study focused on detrusor function

Prostate cancer is common in aged men and radical prostatectomy is established as a therapeutic measure. However, to date there is little information about its impact on voiding function. We conducted a prospective clinical study to elucidate the impact of radical prostatectomy on voiding function in 17 patients with prostate cancer, by urological evaluation including filling and voiding cystometry (pressure flow study). The patients who were estimated as having weak detrusor function including very weak detrusor function at 3 months postoperatively had significantly more frequent urinary incontinence compared with the others (p < 0.05). Of 8 patients who showed urinary incontinence for more than 3 months, 7 (88%) patients developed weak detrusor function at 3 months after operation, but 4 of them were estimated as having normal detrusor function preoperatively. These patients revealed reduced maximum flow rate and significantly increased quality of life score compared with the other patients (p < 0.05). An initially reduced bladder compliance disclosed a tendency to a rapid return to normal with time after surgery. Detrusor overactivity itself and neoadjuvant antiandrogen therapy were not related to prolonged postoperative urinary incontinence. The present study indicates that caution is required when administering medication that could potentially affect detrusor function, regardless of the type of preoperative detrusor function, in patients with persistent urinary incontinence or a reduced urinary stream. Particular emphasis is laid on the importance of urodynamic assessment of post-prostatectomy detrusor function and appropriate management modalities based on the results.     

A case of intrapelvic retroperitoneal ganglioneuroma

A 61-year-old man presented with an asymptomatic intrapelvic retrovesical tumor, measuring 8.5 cm in maximum diameter, which was revealed by preoperative diagnostic imaging for transverse colon cancer. When he was referred to our department one year after hemi-colectomy, this tumor showed no change in size, but there was some suspicion of concomitant malignancy because of large tumor size and contrast enhancement in a region adherent to the right seminal vesicle. En-bloc resection of the tumor along with the right seminal vesicle was performed retroperitoneally. The tumor was diagnosed histopathologically as retroperitoneal ganglioneuroma. Herein, we report this rare case of intrapelvic retroperitoneal ganglioneuroma, and present a brief review of the relevant literature including the present case.     

Synergistic induction of apoptosis of rheumatoid arthritis synovial cells by H<Subscript>2</Subscript>O<Subscript>2</Subscript> and <Emphasis Type="Italic">N</Emphasis>-acetyl-leucyl-leucyl-norleucinal

 The effects of proteolysis inhibitors on hydrogen peroxide (H₂O₂)-induced apoptosis were examined in cultured human synovial cells of rheumatoid arthritis (RA) patients. RA synovial cells were resistant to apoptosis induced by H₂O₂. In the presence of 100 μM N-acetyl-leucyl-leucyl-norleucinal (ALLN, known as calpain inhibitor 1 and also a proteasome inhibitor), but not N-acetyl-leucyl-leucyl-methioninal (ALLM), apoptotic cell death was elicited by 400 μM H₂O₂ at a concentration that alone never induced cell death. ALLN induced the expression of tumor suppressor p53 protein and p21^WAF-1 protein, probably through inhibition of proteasome. H₂O₂ further potentiated ALLN-induced p53 expression. H₂O₂ appeared to activate c-Jun N-terminal kinase (JNK) as well as extracellular signal-regulated kinase (ERK) and AKT. After administration of H₂O₂ and p53 induction by ALLN, we found that either one alone is insufficient to induce apoptosis of RA synovial cells but their combination synergistically does so. These results suggest that induction of p53 by ALLN may be potentially important for triggering H₂O₂-induced apoptosis processes in RA synovial cells. Received: September 17, 2002 / Accepted: January 22, 2003 RID="*" ID="*" Offprint requests to: K. Shimizu Acknowledgments. We thank Eriko Wada for excellent technical assistance. This work was supported in part by grants-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (12671405) and a Sasakawa Scientific Research Grant from The Japan Science Society.     

Spontaneous necrosis of hepatocellular carcinoma: a case report

BACKGROUND: Spontaneous regression of a malignant tumor is a rare phenomenon. So far, 13 cases of spontaneous regression of hepatocellular carcinoma (HCC) have been described in the English literature. We report a case of HCC, with spontaneous complete necrosis demonstrated by histological examination. METHODS: A 73-year-old male was admitted to our hospital complaining of general fatigue. CT and US revealed a huge mass measuring 9.5 cm at the left lobe. Angiographies showed hypovascular tumor stains. The levels of alpha-fetoprotein (AFP) and PIVKA-2 on admission were high, at 55 ng/ml and 62,300 mAU/ml, respectively. We diagnosed hypovascular HCC and performed a left lobectomy on October 16, 2000. RESULTS: In the histological examination, no viable cells were found. The levels of AFP and PIVKA-2 had already decreased to 14 ng/ml and 1,420 mAU/ml, before laparotomy. CONCLUSION: Changes in tumor markers and histological findings reveal that this phenomenon occurred without specific treatment.     

Spinal cord lesions of multiple sclerosis

The neuropathological findings of the spinal cord lesions of six human multiple sclerosis cases are described. The spinal cord was extensively necrotic and occasionally cystic in five remitting and relapsing cases. The lesions became more severe as the disease course prolonged and relapses increased. The spinal cords of two cases in particular, with a duration of illness of more than 5 years, were severely atrophic. In these cases, peripheral type remyelination was prominent, although central type remyelination was minimal. In contrast, in mouse spinal cords, in which experimental demyelination and remyelination were induced by ethidium bromide, the degree of central type remyelination and peripheral type remyelination was almost the same. Longitudinal sections of the transitional zone between the areas of central type remyelination and peripheral type remyelination contrained Ranvier nodes, in which central type myelin and peripheral type myelin were situated side by side around a central type axon. These transitional zones were similar to those of the normal transitional zone between the central nervous system and peripheral nervous system of the nerve roots. One chronic progressive case, despite the very long duration of illness, showed classical sharply demarcated demyelinated lesions with marked fibrillary gliosis. The spinal cord of this case was not atrophic and axons were well preserved.     

DNA lability induced by nimustine and ramustine in rat glioma cells.

The DNA labile sites induced by two nitrosoureas, nimustine (ACNU) and ramustine (MCNU) synthesised in Japan, have been examined in highly reiterated DNA sequences of rat glioma cells. Reiterated fragments of 167 and 203 base pairs (bp), obtained after Hind III and Hae III restriction endonuclease digestion of rat glioma cells DNA, were used as target DNA sequences to determine the labile sites. In vitro reaction with ACNU and MCNU resulted in scission products corresponding to the locations of guanine. Subsequent piperidine hydrolysis produced more frequent breaks of the phosphodiester bonds at guanine positions, thus forming alkali-labile sites.