Balloon pulmonary valvuloplasty for double outlet right ventricle with valvular pulmonary stenosis

A male neonate presented with cyanosis. Echocardiograms showed a double outlet right ventricle, an absent outlet septum, a subaortic ventricular septal defect and valvular pulmonary stenosis. Balloon pulmonary valvuloplasty was performed at 19 days of age, resulting in an immediate increase of the systemic arterial oxygen saturation from 67 to 87%. As far as could be found, this is the first report of a patient with a double outlet right ventricle without the outlet septum who was clinically observed and underwent balloon pulmonary valvuloplasty.     

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis

Three patients with idiopathic retroperitoneal fibrosis underwent laparoscopic ureterolysis. Two patients were bilateral cases which were performed successfully as a one stage procedure. Another patient, who was unsuccessfully treated, had a long ureteral stricture. Laparoscopic ureterolysis may be a useful alternative to open surgical management especially in bilateral cases, except for patients with a long ureteral stricture.     

Successful treatment of recurrent vesicourethral stricture after radical prostatectomy with holmium laser: Report of three cases

We report three cases with severe anastomotic strictures, which recurred several times after radical prostatectomy despite repeated treatments of urethral dilation, internal urethrotomy and/or transurethral resection. All three cases were finally treated with holmium laser successfully without any intraoperative or postoperative complications after repeated failures of each treatment. There were two specific characteristics in these three cases: the early onset of the stricture and the pinhole opening located on the top (12-o'clock) of the stricture wall.     

Case of leiomyosarcoma of the renal pelvis

A 54-year-old man presented at the Mibayashi clinic with bowel discomfort. Ultrasonography showed a left renal mass and the patient was referred to Noto General Hospital for urological evaluation. Results of the physical examination were unremarkable, but computed tomography and magnetic resonance imaging demonstrated a large tumor in the middle of the left kidney. The patient underwent left nephrectomy. On hemisection of the kidney, a firm tumor, measuring 8 x 7.5 cm, was seen occupying the renal pelvis. The histological diagnosis was leiomyosarcoma arising from the right renal pelvis. No treatment was provided after surgery and no recurrence was observed 6 months postoperatively.     

Successful cure of dermatomyositis after treatment of nonseminomatous testicular cancer

Although the association between dermatomyositis and cancer is well recognized, there have been a limited number of reports of dermatomyositis associated with testicular cancer. We report the case of a 31-year-old man who was diagnosed with dermatomyositis. Because the patient's serum levels of alpha-fetoprotein and human chorionic gonadotropin beta subunit were elevated, the patient was referred to our department. Physical examination revealed an induration (2 cm x 2 cm) in the left testis and the patient was diagnosed with stage IIIB left testicular cancer. A left high orchidectomy was then performed, and pathological examination revealed embryonal carcinoma. The patient was started on a systemic chemotherapeutic (etoposide, ifosfamide and cisplatin; VIP) regimen. After the third chemotherapy session, metastases had completely disappeared, the serum levels of alpha-fetoprotein and human chorionic gonadotropin beta subunit had normalized and the dermatomyositis symptoms had improved. Cancer is known to be a trigger of dermatomyositis. This case illustrates the importance of palpation of the testes in young patients with dermatomyositis.     

Cyclic peptides.

cyclo(-l -Pro-l -Val-l -Pro-l -Val-) (1L) and cyclo(-l -Pro-d -Val-l -Pro-d -Val-) (1D) were synthesized by the conventional method for peptide synthesis. Conformations of 1L and 1D in solution were studied. Compound 1L has a cis-trans-cis-trans backbone conformation with C₂ symmetry in CDCl₃. This conformation is slightly different from that in crystalline state and in DMSO-d₆ solution. Compound ID has a cis-trans-cis-trans conformation in DMSO-d₆ and an all-trans conformation in trifluoroethanol-d₃. Compound 1L retarded stem-growth of rice seedlings and, in contrast, compound 1D promoted root-growth of rice seedlings.     

CYCLIC PEPTIDES

Four stereoisomers of a cyclic depsidipeptide containing a lysine and a 2-hydroxy-3-phenylpropanoic acid (Hpp) residue have been synthesized and their susceptibility toward trypsin examined. Trypsin hydrolyzed cyclo(-L-Lys-L-Hpp-) (I-LL) and cyclo (-L-Lys-D-Hpp-) (I-LD) rapidly and cyclo(-D-Lys-L-Hpp-) (I-DL) and cyclo(-D-Lys-D-Hpp-) (I-DD) very slowly. Proteolytic coefficients of these substrates and a reference compound are shown as follows: I-LL, 112; I-LD, 34; I-DL, 0.34; I-DD, 0.11, and Ac-L-Lys-OEt, 44. Possible mode of action of trypsin on these substrates was discussed.