Yuzo Koyama

EVIDENCE FOR INVOLVEMENT OF THE SUBCOERULEUS NUCLEUS AND NUCLEUS RAPHE MAGNUS IN URINE STORAGE AND PENILE ERECTION IN DECEREBRATE RATS

PURPOSE Micturition and male sexual activity require the lower urinary tract to function. During the sexual act, micturition must be inhibited and urine stored in the bladder. We studied the role of the brainstem in relation to both micturition/urine storage and penile erection in rats. MATERIALS AND METHODS Wire electrodes were placed on the dorsal nerve of the penis and microelectrodes for stimulation were introduced into the brainstem in decerebrate male rats. Electrical stimulation was used to locate optimally responding sites by monitoring the isovolumetric intravesical pressure and intracavernous pressure. RESULTS Electrical stimulation of the dorsal nerve of the penis, the subcoeruleus nucleus in the rostral pons, and the nucleus raphe magnus in the caudal pons increased intracavernous pressure, but inhibited rhythmic bladder contractions. Electrical stimulation of Barringtons nucleus (the pontine micturition center in the rat) in the rostral pons induced bladder contraction. Stimulation of the pontine reticular formation did not increase intracavernous pressure. Acute transection of the thoracic spinal cord eliminated rhythmic bladder contractions, but gave rise to sporadic increments of intracavernous pressure. CONCLUSIONS This electrophysiological study demonstrated that the subcoeruleus nucleus and nucleus raphe magnus are involved in both urine storage and penile erection, and that their physiological functions are reciprocally controlled; so that erection leads to inhibition of micturition.

TUBERCULOUS EPIDIDYMO-ORCHITIS

In the clinical course of epididymitis in a forty-four-year-old male patient, enlargement of ipsilateral testis developed which was difficult to distinguish clinically from testicular tumor. High inguinal orchiectomy was performed. Microscopic sections revealed many granulomas with caseous necrosis and giant cells. Tuberculous bacilli also were demonstrated in the histologic examination.

Influence of Immunosuppression in HTLV-1–Positive Renal Transplant Recipients

THE USE OF IMMUNOLOGY suppression in renal transplant patients enables opportunistic development of not only infections, but also malignancies. One such example is the RNA retrovirus human T cell lymphotrophic virus–1 (HTLV-1). This retrovirus has been implicated in causing the lymphoproliferative disorder, Adult T-cell leukemia/lymphoma (ATL). ATL is an insidious disease, usually presenting after a long latency period and exhibiting low morbidity. HTLV-1 had also been associated with others such as HTLV-1–associated myelopathy (HAM/ TSP), HTLV-1–associated bronchopneumonopathy, HTLV-1–associated arthropathy, uveitis, Sjögren’s syndrome, and glucose tolerance disorder.

Transitional cell carcinoma of the renal pelvis forming tumor thrombus in the vena cava

Abstract A 47‐year‐old man presented with a left renal incidentaloma without hematuria. The tumor was complicated by inferior vena cava (IVC) thrombus extending from Th11 to L4. A temporary IVC filter was introduced prior to surgery. A midline incision was used to perform a left radical nephrectomy and en bloc lymphadenectomy with excision of the inferior vena cava from above the level of the left renal vein to 2.5 cm above the confluence of the common iliac veins. The pathological diagnosis was invasive transitional cell carcinoma. The tumor thrombus consisted of transitional cell carcinoma that histologically invaded the walls of the IVC. He died of cancer 17 months after the operation for the liver metastases. This is the 18th case report of such a presentation in the literature.

Studies on alpha-fetoprotein produced by renal cell carcinoma.

A 58‐year‐old man was found to have a Stage IV primary renal cell carcinoma (RCC) invading the colon and producing alpha‐fetoprotein (AFP). The preoperative serum AFP level of 418 ng/ml had decreased to the normal level of 0.9 ng/ml 3 weeks after the radical operation. As the high serum AFP level in RCC without metastasis to the liver is a rare condition, histopathologic studies were performed on surgical specimens. Histogically, the tumor was clear cell adenocarcinoma and AFP was detected in tumor cells immunohistochemically. A Concanavalin A (Con A) sepharose affinity chromatogram was performed to detect the component of AFP in this case. The Con A nonreactive fraction rate was as high as 47%, which indicated that the AFP of this RCC was of fetal type.

Immature Renal Tissue in Inguinal Canal

A 3-year-old boy underwent an operation for a right undescended testis. A small, elastic, hard mass attached loosely to the spermatic cord was noted in the inguinal canal away from the testis and epididymis. Pathological examination of this mass revealed mesonephric remnant tissue.

Glyoxylate determination in rat urine by capillary electrophoresis

Abstract Oxalate is important in the study of renal stone formation and is derived from the endogenous metabolism of glyoxylate. The aim of this study was to determine urinary glyoxylate levels by capillary electrophoresis (CE). Urine specimens were obtained from 25 male Wistar rats (16 rats intravenously injected with 10 mg or 20 mg glyoxylate and nine controls) by bladder puncture 1 h after administration of glyoxylate or saline. Urinary glyoxylate was measured by CE using an electrolyte composed of 5 mmol/L pyridinedicarboxylic acid and 0.5 mmol/L cetyltrimethylammonium bromide (pH 5.6 and 11.0). The mean ± SD urinary glyoxylate concentration was 43.1 ± 14.7 μmol/L in control rats, 722.8 ± 165.5 μmol/L in rats given 10 mg of glyoxylate and 1290.0 ± 470.8 μmol/L in rats given 20 mg of glyoxylate. The mean ± SD recovery after spiking 675.7 μmol/L of glyoxylate into 16 urine specimens was 98.82 ± 12.81%. When the reproducibility of urinary glyoxylate determination was assessed, the intra‐assay coefficient of variation (CV) ranged from 1.38 to 2.59% and the inter‐assay CV ranged from 2.94 to 6.69%. Capillary electrophoresis enables sensitive and reproducible determination of urinary glyoxylate levels in rats. This method appears to be suitable for laboratory use and has the advantage of determining glyoxylate and several other urinary anions simultaneously.

Pelvic congestion syndrome caused by inferior vena cava reflux

We present a female patient who had pelvic congestion syndrome caused by inferior vena cava reflux associated with tricuspid regurgitation, but without other symptoms or signs related to her tricuspid regurgitation. Bladder pumping therapy was effective in improving her symptoms.

Transcatheter embolization for the rupture of congenital arteriovenous malformation of the kidney in pregnancy

We report a case of gross hematuria owing to rupture of an arteriovenous malformation at 22 weeks of gestation. Transcatheter embolization was performed successfully. A healthy newborn was delivered by cesarean section 4 months after the embolization.

Effect of Injury to the Dorsal Funiculus of the Thoracic Spinal Cord on Micturition in Decerebrate and Freely-Moving Cats

Bladder sensation is transmitted both via the spinothalamic tract in the lateral funiculus and the dorsal system in the dorsal funiculus. We transected the dorsal funiculus in 10 female cats to clarify the functional roles of these two ascending pathways. The dorsal funiculus was transected at T10 in 5 decerebrate and 5 freely-moving cats, and micturition parameters were compared before and after transection. Transection of the dorsal funiculus did not affect any of the parameters of reflex micturition in the 5 decerebrate cats. Within 1 week after transection, 4 of the 5 freely-moving cats used the normal micturition posture, but the remaining one performed micturition in a prone position as if she had lost micturition sensation. All 5 cats urinated with a normal micturition posture by 2 weeks after transection. The mean single voided volume was decreased transiently up to 1 week, but returned to normal by 2 weeks after transection. None of the 5 cats had any residual urine before and after transection. Both the ascending and descending limbs of the micturition reflex pass through the lateral funiculus. Bladder sensation is transmitted both via the spinothalamic tract coursing in the lateral funiculus and the dorsal system in the dorsal funiculus. The dorsal system may play a major role in the transmission of bladder sensation to the cerebral cortex, but may not be essential.