Hiroshi Tomomasa

Bilateral Emphysematous Pyelonephritis with Autosomal-Dominant Polycystic Kidney Disease Successfully Treated by Conservative Method

Emphysematous pyelonephritis (EPN) is an uncommon and potentially life-threatening necrotizing inflammation of the renal parenchyma. EPN associated with autosomal dominant polycystic kidney disease (ADPCK) is extremely rare. We report such a case of bilateral EPN with ADPCK that was successfully treated with conservative methods. To our knowledge, our case is only the second to document bilateral EPN occurring with ADPCK and the first one to be treated successfully with conservative methods.

Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: An initial clinical study

Background: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods.

Recombinant human interleukin‐1 beta analogue as a regulator of hematopoiesis in patients receiving chemotherapy for urogenital cancers

Ten patients with advanced urologic cancers who were scheduled to receive at least two courses of chemotherapy were enrolled in this trial. Fifty thousand units of recombinant human interleukin‐1 (IL‐1) beta analogue OCT‐43 (Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan) was administered subcutaneously only once or twice when severe neutropenia (less than 500/μl) continued for 2 consecutive days. In eight patients, OCT‐43 was not injected in the first course of chemotherapy as a control, but was injected in the second course. The durations of leukocytopenia (less than 2000/μl) and neutropenia (less than 1000/μl) were significantly shortened in the second course compared with those in the first course in those eight patients. Recovery of neutrophil number from the lowest number was also significantly faster in the second course. Thus, OCT‐43 was considered to have hematopoietic activities. However, single or double injection of OCT‐43 did not affect the numbers of eosinophilic or basophilic granulocytes, monocytes, or platelets. Adverse effects associated with OCT‐43 injections were high fever and chills, but they were controlled by indomethacin.

Damaging Effects of Cisplatin on Mouse Spermatozoa

The effect of cis-diamminedichloroplatinum (cisplatin: CDDP) on mouse spermatozoa was evaluated quantitatively by means of equilibrium sedimentation in Percoll. CDDP was administered subcutaneously at doses of 1, 3, and 10 mg/kg/week for 5 weeks. After different periods (1, 3, and 10 weeks) without CDDP, the quality of epididymal sperm was evaluated by sperm count, motility, morphology of sperm, and the apparent density of sperm. At 10 mg/kg dose, about 80% mortality occurred during the administration period. There were no sperm even 10 weeks after discontinuing CDDP. With the 3 mg/kg dose, sperm count, motility, and normal morphology of sperm declined after 1 and 5 weeks, but recovered to the control level after 10 weeks. The sperm distribution profiles in the Percoll gradient were quite different among the groups. The control sperm showed two separated peaks in the gradient, whereas the peak of sperm at 1 and 3 mg/kg were shifted forward to lighter apparent density. CDDP causes a reduction in sperm apparent density and impairs semen quality in mice.

Testicular Injury: Late Results of Semen Analyses After Uniorchiectomy

Semen parameters from 4 patients with testicular injury after uniorchiectomy were investigated. Semen volume and sperm morphology were not affected after the operation, but sperm count and motility were severely diminished. Two of 4 cases showed azoospermia, and the other 2 cases showed low values in both sperm count and motility. After 150-300 days from the operation, 2 cases recovered to the normal range in sperm count while the other 2 remained in the abnormal range. In sperm motility, 3 cases recovered to the normal range but the rest remained abnormal. The results suggest that long-term follow-up in semen parameters is needed when unilateral orchiectomy is performed.

INDIVIDUAL VARIATION IN SEMEN PARAMETERS OF HEALTHY YOUNG VOLUNTEERS

Individual variation in semen parameters was investigated in healthy young volunteers. Semen samples were collected approximately once a month over a one-year period for a total of 93 samples (5 to 10 samples per subject) from 12 volunteers in their twenties. Semen analysis was carried out according to the WHO Manual. The amount of variation in each semen variable was calculated for each subject by dividing the maximum value by the minimum value. The results showed that the semen volume varied by 1.9u2009±u20090.8 fold (1.3 to 4.2 fold), the sperm concentration by 4.8u2009±u20094.3 fold (1.5 to 17.2 fold), the percentage of sperm with forward progression by 2.8u2009±u20091.4 fold (1.6 to 6.4 fold), the percentage of sperm with rapid linear progression by 3.4u2009±u20092.6 fold (1.7 to 10.9 fold), the percentage of sperm with normal morphology by 1.9u2009±u20090.4 fold (1.3 to 2.4 fold), and the percentage of live sperm by 1.5u2009±u20090.4 fold (1.1 to 2.6 fold). A between-group comparison showed significant differences in all of the variables except the percentage of sperm with normal morphology. These results suggest multiple and considerable semen analyses are needed when evaluating semen parameters.

Plasmacytoma of the testis.

Extramedullary plasmacytomas of the testes are extremely rare tumors, especially when occurring in the absence of precocious or concurrent diagnosis of multiple myeloma. This is a case report of an 83-year-old man with a solitary plasmacytoma of the left testis. Immunoperoxidase studies, performed on histologic specimens after radical orchiectomy, showed a monoclonal staining of intracellular immunoglobulin for IgG-lambda type. He has been well for more than 14 months with no evidence of local recurrence or multiple myeloma.

XX-male syndrome bearing the sex-determining region Y

The case of a 25-year-old man who presented for evaluation of infertility is described. The physical examination revealed testicular atrophy without gynecomastia. Repeated seminal analyses showed azoospermia, and serum hormonal levels suggested a state of a hypergonadotropic hypogonadism. Chromosomal analysis demonstrated 46XX. Polymerase chain reaction revealed the existence of a sex-determining region Y. The etiology of this rare sex reversal syndrome is discussed and cases reported in Japan are reviewed.

Gonadal Function in Patients with Testicular Germ Cell Tumors

The gonadal function of 18 patients with testicular germ cell tumors was evaluated. Seminal parameters after orchiectomy were examined in 15 patients. Six of them were available for follow-up observation after 2 or 3 courses of adjuvant chemotherapy. Serum gonadal hormones before and after orchiectomy were evaluated in 7 patients (testosterone and PRL were not examined in one patient). Five of 15 (33.3%), 8 of 15 (53.3%), 13 of 15 (86.7%), 7 of 13 (53.8%), and 9 of 12 (75.0%) had abnormal values in seminal volume, sperm concentration, motility, morphology, and vitality, respectively. The sperm concentration gradually improved after chemotherapy following orchiectomy in 5 of 6 (83.3%) patients. In all the patients examined, serum levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) increased after orchiectomy. Serum levels of testosterone increased in 4 patients, but decreased in 2 after orchiectomy. These findings suggest that several factors, including preexisting intrinsic defect and disturbance of the hypothalamus-pituitary-gonadal axis, are involved in the deterioration of gonadal function in patients with testicular germ cell tumors.

Thymidine Phosphorylase and Dihydropyrimidine Dehydrogenase in Bladder Cancer

Thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) levels in transitional cell carcinoma of the bladder resected from 38 patients were examined by ELISA. TP levels in high-grade and invasive cancer were significantly higher than those in low-grade and superficial cancer, respectively. No significant differences in the DPD levels were observed among grades and stages, but the DPD/TP ratio was significantly lower in grade 3 tumor than in grade 1. These results demonstrated that 5′-deoxy-5-fluorouridine seemed to be useful for managing patients with grade 3 cancer. The present study also suggested that we might be able to exclude cases of bladder cancer in which 5-fluorouracil group medicines would be inappropriate candidates in treatment options by measuring both TP and DPD levels in the tumor.