Manabu Ishigooka

Therapeutic Outcome of Primary Aldosteronism: Adrenalectomy Versus Enucleation of Aldosterone-Producing Adenoma

Our followup study of 48 patients with primary aldosteronism concerns the results of 2 different operative methods. After preoperative localization of the unilateral solitary tumor 22 patients underwent unilateral adrenalectomy and 26 underwent enucleation of aldosterone-producing adenoma. Both operative methods improved hypertension, hypokalemia, the low urinary sodium-to-potassium ratio, suppressed plasma renin activity, high plasma aldosterone concentration, high urinary aldosterone excretion and high urinary kallikrein excretion in similar orders of magnitude for 5 years. Levels of plasma cortisol and plasma adrenocorticotropic hormone following respective operations were also identical. Five years postoperatively, ambulation and furosemide administration under low sodium diet stimuli remarkably enhanced plasma renin activity and plasma aldosterone concentration in the aldosterone-producing adenoma enucleation group (p < 0.001), almost similar to that of normal subjects but increment magnitudes were slight (p < 0.05 to < 0.01) in the adrenalectomy group. Preoperatively, angiotensin II infusion failed to increase plasma aldosterone concentration in patients with primary aldosteronism. After respective operations, responses of plasma aldosterone concentration to angiotensin II infusion and of plasma cortisol to adrenocorticotropic hormone administration in the aldosterone-producing adenoma enucleation group were more sensitive than those in the adrenalectomy group. There was no remission of recurrent hyperaldosteronism in either group throughout the study. These results suggest that angiotensin II induces aldosterone release by an activation of tumor uninvolved cortical cells and that the enucleation of aldosterone-producing adenoma is more preferable than unilateral adrenalectomy.

The male chronic pelvic pain syndrome

Abstract Suffering chronic pain is a common and debilitating problem that significantly impairs the quality of life of affected patients. Because we continue to struggle with chronic pelvic pain disorders both diagnostically and therapeutically, a neuro-behavioral perspective should be used in an attempt to explain pathways and neurophysiological mechanisms, and to improve diagnostics and treatment of male pelvic pain. First, however, malignant and acute/chronic bacterial disease has to be excluded as a cause of chronic pain in every single case. Then diagnostic approaches should screen for lower urinary tract dysfunction, pelvic floor functional disorders, and disturbed reflex integrity within the pelvic area. Treatment approaches for the male chronic pelvic pain syndrome could be divided into causal and symptomatic. Causal treatment approaches try to influence basic mechanisms generating and supporting chronic pain. In most cases a symptomatic approach is needed to relieve pain immediately. Because generally accepted treatment protocols and studies are missing, the following approach in the individual patient is recommended: (1) symptomatic treatment for immediate pain relief, (2) diagnostic work-up, (3) causal treatment trial.

Spontaneous Hemorrhage during Pregnancy Secondary to Renal Angiomyolipoma

We report a case of spontaneous hemorrhage secondary to renal angiomyolipoma treated with percutaneous transcatheter arterial embolization. Fourteen and 18 months after the procedure, the patient showed repeated spontaneous hemorrhage during pregnancy. However, a healthy female infant was delivered at the 39th week of the pregnancy. We discuss the management of renal angiomyolipoma in young married women before pregnancy.

Modulation of the urethral pressure by high-frequency block stimulus in dogs

Nerve conduction block by high-frequency stimulus has been used as a method to modulate the contractile force of skeletal muscles. This paper describes the effect of block stimulus on the modulation of urethral closure pressure in dogs. Tetanic stimulus was applied through a pair of electrodes wrapped about the bilateral pudendal nerves and high-frequency stimulus was superimposed through another pair of electrodes wrapped about 1 cm distalward along the nerves. Urethral closure pressure was measured through a transurethral UPP catheter. High-frequency stimulus over 300 Hz reduced elevated urethral closure pressure, which was induced by tetanic stimulus, up to 30-45%.

Therapeutic experience of hyperbaric oxygenation in radiation colitis

PURPOSE: The usefulness of the hyperbaric oxygenation in a patient with radiation colitis was evaluated. METHODS: The patient had severe bleeding from the large bowel which resulted from a pelvic radiation therapy for prostatic carcinoma and was histologically diagnosed as radiation colitis. Hyperbaric oxygenation therapy consisting of 100 percent oxygen inhalation at two absolute atmospheric pressures 90 minutes daily for 30 days was performed. RESULTS: The treatment succeeded in stopping gross hemorrhage and reversed endoscopic bowel findings. CONCLUSION: The effect of the hyperbaric oxygenation therapy of radiation colitis is elucidated.

Effects of estrogen and progesterone on urinary bladder in female rabbit: evaluation by quantitative morphometric analysis.

OBJECTIVES To investigate possible effects of estrogen and/or progesterone on the histologic characteristics of female rabbit urinary bladders, we carried out quantitative morphometric analysis of the rabbit bladders. METHODS Mature female rabbits were treated by ovariectomy with and without successive estrogen and/or progesterone administration. Area densities of the connective tissue (CT) and smooth muscle (SM) cells, the area of single SM cells, and the thickness of the bladder wall were determined by computer-assisted quantitative morphometric analysis. RESULTS Six weeks after each treatment, ovariectomy alone resulted in a decrease in CT density of the bladder. Successive estrogen treatment increased the bladder wet weight and SM cell density within the bladder wall. Progesterone treatment reduced CT degradation in ovariectomized rabbits. Sex steroids did not significantly influence the area of each SM cell. There was no significant difference in histologic characteristics between the rabbits treated by estrogen alone and those treated by combination (estrogen and progesterone) therapy. CONCLUSIONS Ovariectomy and successive hormonal replacement therapy resulted in morphologic changes within the rabbit urinary bladder. Cotreatment with progesterone did not significantly change the morphologic findings produced by estrogen treatment alone.

RECURRENCE OF URETHRAL STRICTURE AFTER SINGLE INTERNAL URETHROTOMY

Recurrence of urethral stricture after single internal urethrotomy was investigated in 66 patients with special reference to some factors which would influence restricturing. In the present study, recurrence rate was 16.7% (11 patients). Recurrences occurred within an average of 11.9 months. Factors that had no influence on restricturing were age, aetiology, site of the stricture and duration of indwelling catheterization. On the other hand, stricture length appeared to influence the outcome (χ2, p<0.001). Short stricture (≤10 mm) showed only 4.4% recurrence rate, while 42.9% in long stricture (>10 mm). Internal urethrotomy appeared to be effective particularly when the stricture was short, while it seemed difficult to treat long strictures by single internal urethrotomy.

Pericentric inversion of chromosome 9 in infertile men

Reproductive condition was studied in 6 infertile men with pericentric inversion of chromosome 9. Semen analyses revealed one azoospermia, one oligozoospermia, three asthenozoospermias and one normozoospermia. Four cases showed normal levels of plasma gonadotropins and testosterone. The response of plasma testosterone to human chorionic gonadotropin was within the normal range in all cases. However, the administration of LH-RH resulted in abnormal response of plasma gonadotropin in all patients. These results indicate that infertile males with pericentric inversion of chromosome 9 have an abnormality in the hypothalamic-pituitary-testicular axis.

Relative and total volume of histological components in benign prostatic hyperplasia: Relationships between histological components and clinical findings

To investigate the correlation between histological differences and clinical findings in patients with benign prostatic hyperplasia (BPH), quantitative morphometrical analysis on prostate was performed on 26 specimens obtained by TURP. The relative and total volume of each histological component were obtained. In this series, the proportion of fibrous tissue element showed a weak positive correlation with prostatic volume (r = 0.499, P = 0.0087). The relative volume of the smooth muscle component showed an inverse correlation with prostatic volume (r = −0.488, P = 0.0105). Patient age and symptom score showed no relationship with the relative volume of histological components. The total volume of all histological components increased with prostatic volume. However, an increase in the fibrous tissue element appeared to be predominant in prostatic enlargement (r = 0.970, P < 0.0001). Although the total volume of all histological components increased with prostatic size, fibrous tissue appeared to play a major role in prostatic enlargement in BPH.

Serum Prostatic Acid Phosphatase, Gamma-Seminoprotein and Prostatic Specific Antigen in Hemodialysis Patients

Serum concentrations of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostatic specific antigen (PSA) were measured in 31 hemodialysis patients without clinical signs of malignant disease. PAP, gamma-Sm and PSA levels in serum were not significantly different between control and hemodialysis groups. A significant reduction in these tumor markers was not found after dialysis treatment. This indicates that the measurement of PAP, gamma-Sm and PSA in serum is useful for the detection of prostatic cancer in patients undergoing hemodialysis.