A case of secondary Paget's disease of the glans penis originating from bladder cancer

An 81-year-old man had undergone total cystectomy and bilateral ureterocutaneostomy at the age of 66 years. Furthermore, no recurrence or metastasis was observed; but at the age of 80 years he observed a painless rash around the external urethral orifice. As urothelial cancer was suspected, the urethra and glans were biopsied. Through immunohistochemical staining (cytokeratin 7 and 20), the glans biopsy indicated secondary Paget's disease of transitional epithelial origin. A urethrectomy was performed as progression from the urethra was suspected. The pathological examination revealed Paget cells at the glans, but the tumor was not observed permeating into the corpus cavernosum. This presents a rare case of secondary Paget's disease originating from a bladder tumor, and appearing in the glans without intraurethral progression.     

Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A(1) segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A(1) segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.     

Aorto-pseudoaneurysm-ventricular regurgitation after aortic root replacement

We describe a 48-year-old man with aorto-pseudoaneurysm-ventricular regurgitation. It was due to disruption of both proximal and distal anastomoses after aortic root replacement for detachment of a prosthetic valve implanted for a sinus of Valsalva aneurysm with aortic valve regurgitation. The chest was opened during cardiopulmonary bypass using a deep hypothermic circulatory arrest to avoid rupture of the aneurysm because of a close relation between the pseudoaneurysm and the sternum. Aortic root re-replacement was performed successfully.     

Takayasu arteritis developing during treatment of ulcerative colitis with infliximab

A 22-year-old female with ulcerative colitis that was successfully treated with infliximab (IFX), and remained stable following tapered discontinuation of prednisolone, developed anterior neck pain and elevation of C-reactive protein following her fourth administration of IFX. She was diagnosed with Takayasu arteritis (TA) based on neck ultrasound and computed tomography angiography. This is the first report describing the development of TA during treatment of UC with IFX.     

Prediction of endurance running performance for middle-aged and older runners.

The purpose of this study was to develop regression equations that would sufficiently predict the endurance running performance (ERP) of middle-aged and older runners (n = 55, 43-79 years). Among many independent variables which were selected as possible predictors of the ERP, oxygen uptake corresponding to the lactate threshold (VO2@LT), or age was found to be the single best predictor. Some variables representing training habits correlated significantly but only moderately with the ERP. Linear multiple regression equations developed in this study were: V5km = 4.203 + 0.054X1 - 0.028X2 (r = 0.87) V5km = 4.436 + 0.045X1 - 0.033X2 + 0.005X3 (r = 0.89) V10km = 4.252 + 0.042X1 - 0.026X2 (r = 0.79) V10km = 4.371 + 0.037X1 - 0.031X2 + 0.005X3 (r = 0.82) VM = 3.207 + 0.048X1 - 0.022X2 (r = 0.91) VM = 3.707 + 0.038X1 - 0.031X2 + 0.005X3 (r = 0.93) where V5km, V10km and VM are the mean running velocity at 5 km, 10 km and marathon races, respectively, and X1 = VO2@LT (ml kg-1 min-1), X2 = age (year), and X3 = average running duration per workout (min). We suggest that the ERP of middle-aged and older runners can be predicted from a linear combination of VO2@LT and age or a combination of these variables plus average running duration per workout.     

An autopsied case of progressive systemic sclerosis with anti Wa antibody who showed a rapid progression]

An anti Wa antibody was reported as a new t-RNA related protein antibody in 1986. This autoantibody is now considered specific for the diagnosis of progressive systemic sclerosis (PSS). Up to date only 5 cases with anti Wa antibody have been identified. We report here an autopsied case of PSS with this antibody. A 53 years old female was admitted to our hospital because of dry cough and dyspnea in Sep 1987. There were fine crackles and chest X ray revealed interstitial pneumonia. The progressive respiratory failure was treated by steroid pulse therapy effectively. Sclerotic skin changes of hand began to appear in Sep 1988 and rapidly progressed to arms, chest and forehead by Dec 1988. A skin biopsy confirmed PSS changes. An anti Wa antibody was detected by double immunodiffusion and the protein antigen was associated with t-RNA when immunoprecipitation was conducted. She died of heart failure in July 1989. An autopsy revealed the diffuse fibrotic change of the heart and the lung. Cases with anti Wa antibody were shortly reviewed from the literature.     

A neuroendocrinological study in female migraineurs: prolactin and thyroid stimulating hormone responses

To evaluate the change of the neurotransmitter function in migraine, a neuroendocrinological study was performed in eleven female migraineurs and nine female controls. Thyrotropin releasing hormone, luteinizing hormone releasing hormone, and insulin were simultaneously loaded (the Triple test). Before and after loading, serum glucose, prolactin (PRL), thyroid stimulating hormone (TSH), luteinizing hormone, follicle stimulating hormone, adrenocorticotropic hormone, cortisol, human growth hormone and beta-endorphin were measured. The Triple test produced an increase of PRL in both migraine and control groups, but in migraineurs the increase was significantly larger than in controls. TSH also increased in response to the test, but the TSH response in patients was less than in controls, although not significantly so. The responses of other substances showed no significant differences between the two groups. Although dopaminergic hypofunction in migraine has been proposed by some authors, the present findings rather suggest a serotonergic hyperfunction.