Sunao Yachiku

Conservative Treatment of Cystine Calculi: Effect of Oral Alpha-mercaptopropionylglycine on Cystine Stone Dissolution and on Prevention of Stone Recurrence

Abstract Since 1970, 35 patients with cystine calculi have been treated with oral administration of alpha-mercaptopropionylglycine (MPG) for stone dissolution and/or prevention of recurrence. Of these patients 27 received MPG for more than 1 year. The results were satisfactory. Cystine tones were dissolved completely or markedly in 7 of 21 patients and formation of new cystine stones was prevented in 23 of 27. MPG therapy was associated with fewer side effects than are reported generally with D-penicillamine.

Nutritional Risk Factors in Calcium Stone Disease in Japan

The purpose of this study is to examine the nutritional environment affecting calcium stone disease in Japan. The following results were obtained. Renal stone disease in the late 1970s increased by about three times than that of the 1940s . Fats and oils, animal protein and calcium intake increased remarkably after the second World War and milk plus milk products, meat and animal products were increased surprisingly compared with 1950. The most ingested nutrients of calcium stone formers were not much different from the results of the National Nutritive Survey in Japan. But the ingested amount of calcium was unexpectedly small and did not reach the level of the daily nutritional requirement in Japanese (15 mmol). The ingested amount of total protein correlated with urinary calcium excretion and had the highest coefficient of determination to the urinary calcium excretion by multiple regression analysis. We have finished our research of individual dietary habits and suggest that the following individual dietary guidance is the primary treatment for the prophylaxis of renal stone disease.

Evoked central somatosensory potentials after penile stimulation in man

Abstract Evoked cortical and spinal potentials were recorded indirectly following electrical penile stimulation on normal men using computer averaging techniques.

Oral calcium tolerance test and serum calcitonin in calcium stone formers

SummaryNinety-seven male patients with idiopathic calcium urolithiasis and 17 normal male subjects were studied to evaluate the mechanism of idiopathic hypercalciuria with an oral calcium tolerance test, which has been useful in differentiating hypercalciuria. The changes in parathyroid function, such as parathormone and urinary cyclic AMP, and calcium after calcium load differed between absorptive hypercalciuria and renal hypercalciuria. We have confirmed that the change in serum calcitonin after calcium load was also different in these two hypercalciurias. The increase in serum calcium was sufficient to reduce parathyroid function but serum calcitonin was unchanged after calcium load in the control group, in patients with normocalciuria, and those with renal hypercalciuria. Although serum and urinary calcium were more elevated in absorptive hypercalciuria than in the other three groups, parathyroid function was not significantly reduced after loading in absorptive hypercalciuria. In this group only, the serum calcitonin was significantly elevated after calcium load. It is reasonable to suggest that, in this group, because parathyroid function is usually suppressed by intestinal hyperabsorption of calcium, parathyroid function may not be further suppressed by even calcium load. Possibly the significant stimulation of calcitonin may compensate for the lack of suppression of parathyroid function and maintain normal serum calcium levels in absorptive hypercalciuria. These results suggest that the change in serum calcitonin is also useful to differentiate abnormalities of calcium metabolism in patients with hypercalciuria.

CHANGES IN CYCLIC AMP AND ELECTROLYTES AFTER PARATHYROIDECTOMY IN PRIMARY HYPERPARATHYROIDISM

Changes in the excretion of urinary cyclic AMP, calcium and phosphate, and serum calcium, ionized calcium, and magnesium were studied after parathyroidectomy for primary hyperparathyroidism. Urinary cyclic AMP decreased rapidly and 8 of 11 patients had a significant reduction 1 h postoperatively, but changes in serum calcium and ionized calcium were delayed. Serum calcium concentrations closely parallelled those of serum ionized calcium and phosphate excretion returned to normal almost 7 h later than that of cyclic AMP. Excretion of urinary calcium rose rapidly at 4 h after surgery because calcium clearance improved after the reduction in circulating parathyroid hormone. The fall in urinary calcium at about 24 h was due to the subsequent reduction in serum calcium.

Bilateral Trifid Ureters Associated with Fused Kidney, Ureterovesical Stenosis, Left Cryptorchidism and Angioma of the Bladder

The first case of bilateral trifid ureters associated with fused kidney, ureterovesical stenosis, a left undescended testicle and angioma of the bladder is reported. Bilateral ureteroneocystostomy and left orchiopexy were done. The patient is well 3 months postoperatively with no urinary tract infection and stable renal function.

Ultrasonic evaluation of prostatic carcinoma

Twenty-four patients with prostatic carcinoma were examined by transrectal ultrasonotomography. Ultrasound could differentiate prostatic cancer from other prostatic diseases. Since ultrasonic diagnosis is noninvasive, safe, and painless, repeated examinations could be performed, and it was useful to follow patients with prostatic carcinoma after treatment.

Relation between parathyroid hormone and adrenocorticotropic hormone in primary hyperparathyroidism.

Parathyroid hormone is concerned with urolithiasis, and regulated by serum ionized calcium concentration. We thought that parathyroid hormone might also be regulated by a hormone. 1 mg of ACTH injection was given intramuscularly to 6 patients with primary hyperparathyroidism, 6 patients with urolithiasis, and 5 control subjects. Serum calcium significantly increased 2 h after ACTH injection in primary hyperparathyroidism. However in the other two groups, an increase of serum calcium was not observed. Parathyroid hormone increased after ACTH injection in most subjects of all three groups. Calcium concentration in a culture medium of parathyroidectomy increased in 4 cases, and the parathyroid hormone concentration in the culture medium increased in 3 cases after ACTH addition. From these data, we believe that ACTH directly influences the parathyroid glands, and that calcium is released from the parathyroid cells. Therefore, the decrease in calcium concentration in the parathyroid cells activates the excretion of parathyroid hormone. The fact that serum parathyroid hormone increases in most subjects in all groups supports our hypothesis, namely that ACTH acts directly on the parathyroid gland.

Accurate diagnosis of detrusor areflexia using combined uroflowmetry and abdominal wall electromyography

Twenty-three patients who previously demonstrated no detrusor contraction during cystometry were evaluated using a combined uroflowmetry and abdominal wall electromyography. Ten patients voided without abdominal straining (normal detrusor reflexia), 11 could not void without abdominal straining (detrusor areflexia, detrusor weakness, or bladder outlet obstruction), and 2 had equivocal findings with the method.

Serum-Ionized Calcium as a Diagnostic Tool in Hypercalciuria

Serum-ionized calcium (Ca++) was measured in 65 patients with idiopathic calcium urolithiasis. The patients were then divided into hypercalciuric and normocalciuric groups based on the mean + SD of the control group, with greater than 180 mg/24 h in males and greater than 176 mg/24 h in females defined as hypercalciuria. The results showed a decrease in the tubular reabsorption of calcium in the hypercalciuric group, but not in the normocalciuric group. The hypercalciuric group was then further divided into group I with increased filtered load and group II with with normal filtered load. It was suggested that the group I hypercalciurics had absorptive hypercalciuria and group II renal hypercalciuria.