Spontaneous rupture of varicocele testis associated with advanced pancreatic cancer

We report a rare case of strain-induced spontaneous rupture of varicocele associated with renal vein involvement by advanced pancreatic cancer. Computed tomography and color Doppler sonography yielded the correct diagnosis and the patient could maintain quality of life without surgery for acute scrotum.     

Long QT syndrome with insulin-dependent diabetes mellitus: contiguous gene syndrome on chromosome 11p

Abstract. Long QT syndrome (Romano-Ward syndrome) and insulin-dependent diabetes mellitus (IDDM) have been documented as being linked with gene(s) on chromosome 11p although concurrence of the two disorders has not been reported. Our case is a 13-year-old boy with Romano-Ward syndrome accompanied by IDDM. The long QT syndrome seemed to be transmitted in an autosomal-dominant mode because the Q-T intervals of his father and paternal grandfather were longer than normal. There was no family member with an abnormally high level of blood glucose except the patient. The human leucocyte antigen (HLA) haplotypes of the patient and the father were DR4/DR9 and DR2/DR9, respectively. This study suggests that in our patient IDDM, as well as Romano-Ward syndrome, is linked with chromosome 11p in the presence of HLA-DR4. The results support the previous study that chromosome 11p encodes a gene implicated in HLA-DR4-dependent diabetes susceptibility.     

Circadian variations of plasma atrial natriuretic peptide in four types of hypertensive disorder during pregnancy

Summary. Circadian variations in plasma atrial natriuretic peptide were studied, to clarify the characteristic pathophysiology of pregnancy-induced hypertension (PIH). The mean 24-h values (range) of atrial natriuretic peptide in mild and severe PIH, pregnancy-aggravated hypertension, chronic hypertension and normal pregnancy were 130·1 (97·3−207·0), 225·4 (202·8−281·8), 213·1 (183·2−249·5), 81·3 (61·8−116·1) and 77·1 (56·0−123·5) pg/ml, respectively. The values in PIH and pregnancy-aggravated hypertension were significantly higher, although those in chronic hypertension were no different from normal pregnancy. Plasma atrial natriuretic peptide showed a clear circadian rhythm with acrophase in the middle of the night, in mild and severe PIH. In the other hypertensive disorders, a circadian rhythm could not be confirmed. The results indicate that the elevated values of plasma atrial natriuretic peptide in hypertensive disorders during pregnancy relate to generalized vasoconstriction, and that the diurnal rhythm is a specific characteristic of PIH.     

Macrophage-colony stimulating factor (M-CSF) enhances proteinuria and recruitment of macrophages into the glomerulus in experimental murine nephritis

In this study, we examined the effects of macrophage-colony stimulating factor (M-CSF) on glomerular macrophages in lipopolysaccharide (LPS)-induced murine nephritis. Mice injected intraperitoneally with either M-CSF plus LPS, LPS alone, M-CSF alone or saline every day for 8 days were examined for the degree of urine albumin excretion and lymphocyte-function associated antigen-1-positive (LFA-1⁺) cells in peripheral blood as well as renal pathology. From our results, LPS or M-CSF combined with LPS emphasized the degree of proteinuria, glomerular deposition of immunoglobulins and mesangial proliferation, associated with accumulation of macrophages in the glomeruli. However, in immunohistological examination of kidneys from these nephritic mice, neither intercellular adhesion molecule-1 (ICAM-1), which may play an important role in the recruitment of macrophages into glomeruli, M-CSF receptor nor the number of LFA-1⁺ cells in peripheral blood was enhanced by M-CSF. On the other hand, M-CSF alone induced neither proteinuria nor any pathological changes and did not increase the number of glomerular Mac-1⁺ cells above that in saline-treated controls. These results indicate that M-CSF does not directly cause glomerulonephritis but might participate in accelerating the glomerular inflammatory process by stimulating a potent chemoattractant to recruit monocytes-macrophages into the glomeruli.     

FERTILIZATION RATES OF SMALL-HEAD SPERM IN CONVENTIONAL IVF AND ICSI

Five men produced 23 ejaculates in 23 assisted reproductive technology cycles for semen analysis. In 11 of the 14 ICSI cycles and in 5 of the 9 IVF cycles, small-head sperm were found in more than 70% of the cells, having a length of <3.5 µm and a width of <2 µm. In 6 of the 14 ICSI cycles, the embryologist who performed the ICSI was not alerted to the presence of small-head sperm. Subsequent fertilization rate was significantly lower than a) the fertilization rate of the remaining 5 ICSI cycles that acted as a control, in which the embryologist was alerted to the presence of small-head sperm, and b) was lower than the 3 ICSI cycles with normal sperm head ( p <. 05). The 8 cell embryo and blastocyst rates in the former group were also decreased, although not significantly, compared to the latter groups. Likewise, in the 5 IVF cycles with small-head sperm, the fertilization rate was significantly lower than in the 4 IVF with normal sperm head ( p <. 05). Embryologists should be alerted when a high percentage of small-head sperm are detected during routine semen analysis because they may be associated with reduced fertilization and embryo outcome.     

Relationship between obstruction of arteriovenous fistula and plasma level of endothelin-1 in long-term haemodialysis patients

Summary: The relationship between the patency status of the autogenous arteriovenous (A-V) fistula and the plasma level of endothelin-1 (ET-1) was studied in 41 patients who had been receiving routine longterm haemodialysis for more than 10 years. the ET-1 level in the haemodialysis patients (mean ± s.d.=2.1 ± 0.9 pg/mL) was significantly elevated compared with that in healthy controls ( n =16; 1.1 ± 0.4 pg/mL; P < 0.01). the patients were classified into two groups according to whether the original A-V fistula had remained patent for more than 10 years or had been repaired due to frequent (more than twice) obstruction. Among all 41 patients, 21 were receiving recombinant human erythropoietin (rHuEpo) intravenously (i.v.). In the rHuEpo-treated group, the plasma ET-1 ( n =21; 2.4 ± 0.8 pg/mL) was significantly elevated than that in the rHuEpo-untreated group ( n =20; 1.9 ± 0.9 pg/mL; P<0.05). After exclusion of the 21 rHuEpo-treated patients, the ET-1 level in the repaired fistula group ( n =11; 2.3 ± 0.9 pg/mL) was significantly higher than that in the patent original fistula group ( n =9; 1.3 ± 0.7 pg/mL; P <0.02). Based on these results, we conclude that ET-1 shows a close relation to venous stenosis of the A-V fistula which may be due to its vasoconstrictive and smooth muscle cell-proliferating effects.