Shunzo Kawamura

Intracavernous Injection of Prostaglandin E1 for the Treatment of Erectile Impotence

We administered intracavernous injections of 20 micrograms. prostaglandin E1 to 135 patients with impotence, and evaluated the effects and side effects. Among 135 patients who underwent intracavernous injection of prostaglandin E1 complete erection was observed in 83 (62 per cent), while incomplete erection was noted in 33 (24 per cent). In both groups the erection was sufficient for sexual intercourse. Tumescence without rigidity was noted in 12 patients and no response was obtained in 7. Poor response was seen frequently in patients with disorders of the vascular system and/or damage to the cavernous body of the penis. Priapism after the injection was not observed. Moreover, we never observed any other severe side effects. Intracavernous injection of prostaglandin E1 could be applicable to the therapy of impotence, especially that due to neurogenic disturbance. Since prostaglandin E1 acts quickly and loses its validity rapidly it is considered to be a more suitable agent than other vasoactive drugs.

Normotensive primary aldosteronism

A very unusual case of normotensive primary aldosteronism is described. A 25 year old woman first noticed numbness of both hands followed by a typical tetany attack. The blood pressure was within normal ranges. The results of other physical examinations were negative except for the findings of Trousseaus sign. Hypokalemi, increased potassium clearance, disturbed urine concentration and increased circulating plasma volume were noticeable. Diagnosis was established by (1) increased levels of plasma aldosterone, (2) low plasma renin activity, (3) normal adrenocortical function and (4) typical aldosterone-producing adenoma. After removal of the adenoma, the abnormalities subsided. The lack of hypertension in primary aldosteronism is a rare condition. Several possible causes of normotension must be considered, such as the early phase of primary aldosteronism, essential hypotension associated with primary aldosteronism and lack of concomitant secretion of other mineralocorticoids from the adenoma, but these were all negligible. As blood pressure response to the administration of angiotensin II was lower than is typical for primary aldosteronism, and the patient transiently suffered from frequent attacks of blackouts soon after the operation, the cause of normotension was thought to be due to the existence of a hypotensive mechanism which counteracts the increase in blood pressure in primary aldosteronism.

Left Preureteral Vena Cava (Retrocaval or Circumcaval Ureter) Associated with Partial Situs Inversus

We present a rare case of left preureteral vena cava associated with partial situs inversus. A 68-year-old woman was referred to our clinic for further study of left hydronephrosis on computerized tomography. The abdominal viscera were in mirror image and the heart was levocardia. The middle portion of the left ureter was dorsal to the left inferior vena cava. The left ureter was reanastomosed ventral to the inferior vena cava. To our knowledge, coexistence of preureteral vena cava and partial situs inversus has not been reported previously in the literature.

Ureteral Obstruction Secondary to Sigmoid Diverticulitis

A case of ureteral obstruction secondary to diverticulitis is described. The patient had a 2-month history of lower left quadrant pain before an operation. As an intravenous pyelogram showed persistent hydronephrosis, an operation was performed. At the operation, a fibrotic mass which encased the left ureter and sigmoid colon was found. Ureterolysis and segmental sigmoidectomy were carried out. The pathological specimen showed two diverticula and subserosal cicatrization.

Successful Repair of Huge Bladder Diverticulum with a Transurethral Fulguration

We present a 68-year-old man with a huge bladder diverticulum associated with benign prostate hypertrophy treated with transurethral fulguration of the diverticular mucosa in combination with transurethral resection of the prostate. The procedure was well tolerated by the patient and unfavorable symptoms faded after this procedure. Follow-up cystogram demonstrated remarkable reduction of the diverticulum.

Histological analysis of high-grade superficial bladder tumour

Segmental cystectomy or total cystectomy was performed in 26 patients with newly diagnosed stage T1, grade 3 transitional cell carcinoma of the bladder. Their histological specimens were assessed with regard to types of tumour cell spread, small vessel involvement and coexistent carcinoma in situ. Patients were followed for 12 to 141 months.Broad front type and tentacular type spread were seen in 57.7% and 38.5%, respectively. Small vessel involvement was seen in 38.5% of patients. Coexistent carcinoma in situ was found in as many as 65.4%. Urethral recurrence was found in 4 patients out of 26.These data suggest that the high incidence of coexistent carcinoma in situ may be the most important cause of the unsatisfactory prognosis for stage T1, grade 3 bladder cancer.

Failure of blood pressure control by a new combined alpha-and beta-blocking agent (amosulalol) in a patient with pheochromocytoma

A 42-year-old woman with pheochromocytoma received preoperatively a combined alpha-and beta-adrenoceptor blocking agent, amosulalol, exerting some inhibitory action on both receptors. Severe hypertension and remarkable fluctuation of heart rate occurred following this medication. Although it is claimed currently that a combined blocking agent is useful for the management of this disease, it should be administered with caution.