RESUMEN
A 25-year-old man presented to our hospital with the chief complaint of left-sided painless scrotal swelling. Varicocele was diagnosed and high ligation was performed. Two months later, he noticed asymptomatic gross hematuria. Transabdominal ultrasonography and abdominal computed tomographic scanning showed a left renal tumor measuring more than 10 cm in diameter. Radical nephrectomy (thoraco-abdominal approach) was performed and pathological diagnosis was granular cell carcinoma (G2, pT2, INF alpha, pNX, pMX). He then received intramuscular injections of interferon-alpha 3 million units on three days per week. The frequency of renal cell carcinoma was reported to be about 1-3% for individuals in the 20s in the recent Japanese literature, and renal cell carcinoma in a young man with left varicocele is very rare.
Asunto(s)
Adenocarcinoma/complicaciones , Neoplasias Renales/complicaciones , Varicocele/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Adulto , Antineoplásicos/administración & dosificación , Terapia Combinada , Humanos , Inyecciones Intramusculares , Interferón-alfa/administración & dosificación , Neoplasias Renales/diagnóstico , Neoplasias Renales/terapia , Ligadura , Masculino , Nefrectomía , Varicocele/cirugíaRESUMEN
PURPOSE: Psychogenic lower urinary tract dysfunction (PLUTD) is composed of two syndromes; psychogenic frequency-urgency syndrome (PFUS) and psychogenic urinary retention (PUR). We evaluated the patho-physiology of PFUS and PUR, and explored the different pathogenesis in these syndromes. MATERIAL AND METHODS: Forty five patients with PLUTD, consisting of 23 patients with PFUS and 22 patients with PUR were investigated by using the psychological tests: CMI (Cornell Medical Index) and TEG (Todai's Egogram), a quantitative perspiration test in 45 females (23 patients with PFUS and 22 patients with PUR), and simultaneous measurements of voiding cysto-urethrography and urodynamic studies using the Life-Tech 6 channel polygraph in 35 patients (17 patients with PFUS and 18 patients with PUR). RESULTS: The prevalence in ages revealed two peaks, 20 years and 50 to 60 years. Over 25% of them had pyuria more than 10/hpf of WBC. Peak flow rate measured by uroflowmetry showed normal range in PFUS group and decreased in PUR group. The functional vesical volume was less than 100 ml in most patients with PFUS. Residual urine in PUR group was significantly greater. Capacity of the PFUS group were able to hold over 400 ml of contrast instilled through the urethral catheter, despite increased desire to void. Over 15% of the study group with PFUS showed uninhibited systolic contraction of detrusor (> 15 cm H2O) during filling phase. The measurement value of urodynamic parameters demonstrated that a periodic follow-up survey of the upper urinary tract should be performed because of the low compliance bladder in the patients with PLUTD. During voiding phase, the women with PFUS had a tendency to be divided into two groups, hypercontractile or acontractile detrusor. The voiding cysto-urethrography (VCUG) showed a tendency of bladder neck opening on patients with PFUS during filling phase. Most of PLUTD cases demonstrated a round to triangle shape on vesical configuration, which led to a spastic condition of detrusor muscle. We attempted to measure the quantitative perspiration using 3 kinds of loading tests; respiratory, arithmetic and psychological load. In the psychological loading test, we asked 98 questions about their daily lives including occupation, living condition, family relationship and sexual activities. Arithmetic loading test consisted of counting in reverse, subtraction and multiplication. The quantitative perspiration rate resulted in a "positive" in many patients with PFUS. Respiration loading test was performed to measure the respiration volume during 3 large inhales. Most patients with PUR tested within the normal range for respiration except for those patients with decreased or no perspiration during the psychiatric loading test. These results may reflect the psychological elements including suppression and subconscious defense mechanism. Neurosis which was diagnosed as having type III to type IV of the Cornell Medical Index was demonstrated in less than under 40% of patients with PFUS and more than 55% patients with PUR. There was no significant trend or difference between PFUS and PUR detected from Todai's Egogram. CONCLUSIONS: Due to the reflection of many psychological responses, it is necessary to investigate from various examinations including psychological, autonomical and classical urological studies for accurate diagnosis of PLUTD.
Asunto(s)
Retención Urinaria/psicología , Trastornos Urinarios/psicología , Enfermedades Urológicas/psicología , Adolescente , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Neurogénica/psicología , Incontinencia Urinaria/etiología , Incontinencia Urinaria/psicología , Retención Urinaria/etiología , Trastornos Urinarios/etiología , Trastornos Urinarios/fisiopatología , Urodinámica , Enfermedades Urológicas/etiologíaRESUMEN
We report a case of renal oncocytoma associated with acquired cystic disease of kidney (ACDK). A right renal mass was incidentally found on an annual ultrasonography of the kidneys in a 56-year-old female patient who had been on maintenance hemodialysis for 6 years. Computerized tomography (CT) showed a right hypervascular renal mass, suggesting a renal cell carcinoma associated with ACDK. Right radical nephrectomy was performed. The post-operative pathological diagnosis was renal oncocytoma. Renal oncocytoma in ACDK is very rare, and the pathological characteristics of oncocytoma are discussed.
Asunto(s)
Adenoma Oxifílico/etiología , Neoplasias Renales/etiología , Enfermedades Renales Poliquísticas/complicaciones , Adenoma Oxifílico/patología , Femenino , Humanos , Neoplasias Renales/patología , Persona de Mediana EdadRESUMEN
The difference between in vivo and in vitro inhibitory effects on epididymal 5 alpha-reductase was investigated by using epididymides obtained from patients treated with chlormadinone acetate (6-chloro-3,20-dioxo-4,6-pregnadien-17-yl acetate, CMA) or ethinylestradiol (17 alpha-ethynyl-1,3,5(10)-estratriene-3,17 beta-diol, EE2). In the in vitro study CMA exhibited competitive inhibition, whereas EE2 was a noncompetitive inhibitor of human epididymal 5 alpha-reductase. Their in vitro inhibitory effects were weak compared with the effect of finasteride ((-)-N-tert-butyl-3-oxo-4-aza-5 alpha-androst-1-ene-17 beta carboxamide), a steroidal 5 alpha-reductase inhibitor. The Ki values of CMA, EE2, and finasteride were 1.4 x 10(-5) M, 1.5 x 10(-5) M, and 1.3 x 10(-9) M, respectively. Despite their weak in vitro inhibitory potency, CMA and EE2 strongly inhibited testosterone 5 alpha-reductase in vivo. There were regional differences in inhibitions by CMA and EE2 on human epididymal 5 alpha-reductase activity depending on the site of the epididymis; the efferent ductules, the head, the body or the tail. In vivo administration of CMA reduced epididymal 5 alpha-reductase activity by 49.7% to 89.4%. In vivo administration of EE2 reduced epididymal 5 alpha-reductase activity by 82.7% to 96.3%. The apparent Km values for the enzyme in patients treated with CMA or EE2 and untreated patients did not differ significantly. The Vmax values were significantly decreased in treated patients. These findings suggest that the marked in vivo inhibition of 5 alpha-reductase induced by CMA and EE2 was not related to the direct action of these compounds, but resulted from a reduction in the amount of the enzyme.
Asunto(s)
3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/metabolismo , Antineoplásicos Hormonales/uso terapéutico , Acetato de Clormadinona/uso terapéutico , Epidídimo/enzimología , Etinilestradiol/uso terapéutico , Neoplasias de la Próstata/tratamiento farmacológico , 3-Oxo-5-alfa-Esteroide 4-Deshidrogenasa/efectos de los fármacos , Inhibidores de 5-alfa-Reductasa , Anciano , Antineoplásicos Hormonales/farmacología , Acetato de Clormadinona/farmacología , Relación Dosis-Respuesta a Droga , Inhibidores Enzimáticos/farmacología , Epidídimo/efectos de los fármacos , Epidídimo/metabolismo , Etinilestradiol/farmacología , Finasterida/farmacología , Humanos , Masculino , Orquiectomía , Neoplasias de la Próstata/sangreRESUMEN
BACKGROUND: Complications of penile prosthesis implants can be divided into surgical and mechanical failure. We investigated penile prosthesis implants to clarify the surgical and mechanical complications that have arisen in our clinical experience. METHODS: In the 11 years between 1984 and 1995, 83 penile prostheses were implanted in 74 patients ranging from 37 to 82 years of age. RESULTS: Of the 64 malleable and mechanical prostheses, 11 were extracted, including 4 removed because of surgical complications and 2 due to mechanical failure. Of the 19 inflatable prostheses, 6 were removed, including 1 extracted due to surgical complication and 5 extracted due to mechanical failure. Nine reimplantations for 8 patients were performed and all these cases had good results. As a result, 66 out of 74 patients could have coitus after prosthetic surgery. CONCLUSIONS: Penile prosthetic surgery is an established method of treating organic impotence, however, it should only be considered for selected and well-informed patients to avoid complications and revision surgery.
Asunto(s)
Prótesis de Pene/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Coito , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Periodo Posoperatorio , Falla de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
We report a case of urethral condyloma acuminatum with severe dysplasia detected human papillomavirus (HPV) type 11. A 47-year-old male patient visited St. Luke's International Hospital complaining of tumor at the urethral meatus. One small papillary lesion was found and excised. Histopathological examination revealed condyloma acuminatum with severe dysplasia. Immunohistochemical detection for HPV antigen in the specimen of condyloma acuminatum was positive and that of severe dysplasia was negative. In an electron microscopical study, viral particles were demonstrated only in the specimen of condyloma acuminatum. Detection of HPV DNA was performed using in situ hybridization (ISH) and southern blot hybridization (SBH). HPV type 11 was found in both lesions. In conclusion, although previous studies have shown that HPV type 16/18 was especially correlated with genital severe dysplasia and carcinoma, the process of malignant transformation was suggested in the association with HPV type 11.
Asunto(s)
Condiloma Acuminado/microbiología , Papillomaviridae/aislamiento & purificación , Enfermedades Uretrales/microbiología , Condiloma Acuminado/patología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Uretrales/patologíaRESUMEN
Between April, 1988 and August, 1990, the OmniPhase penile prosthesis, a non-inflatable self-contained penile prosthesis, was implanted in 34 patients, aged from 37 years to 79 years, averaging 54.2 years. The etiologies of the impotence were radical surgery for bladder cancer or rectal cancer in 17 patients, diabetes mellitus in 7 patients, vascular abnormality in 3 patients, spinal injury in 2 patients, penile disorders in 2 patients and others in 3 patients. Penile prosthesis was implanted by subcoronal incision under spinal or general anesthesia. Clinical results were evaluated 12 weeks after surgery. Thirty-two patients (94.1%) could have intercourse postoperatively. Eighteen patients (52.9%) were completely satisfied and 14 patients (41.2%) were satisfied, whereas one patient (2.9%) had no improvement and another patient (2.9%) deteriorated. There was no serious complication. However, prosthesis was explanted because of skin erosion in one patient. Pain, which lasted for more than 10 days, was seen in 3 patients (8.8%), penile edema in 11 patients (32.4%), and acute epididymitis in one patient. The obtained results showed that implantation of OmniPhase penile prosthesis is a safe and useful procedure for treatment of organic impotence.
Asunto(s)
Disfunción Eréctil/terapia , Prótesis de Pene , Adulto , Anciano , Disfunción Eréctil/etiología , Disfunción Eréctil/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Neoplasias Pélvicas/complicaciones , Erección Peniana , Prótesis e Implantes , Enfermedades de la Vejiga Urinaria/complicacionesRESUMEN
Extracorporeal shock wave lithotripsy (ESWL) using a Therasonic lithotripter was performed on 30 patients with urinary tract calculi between July, 1989 and February, 1990. The results obtained in 31 cases (one patient had bilateral renal stones) were presented. There were 22 inpatients and 8 outpatients in this series. The stone location was: renal pelvis in 15 cases, renal calyces in 10 cases, parenchyma or diverticulum of renal calyces in 3 cases, ureteropelvic junction in 1 case, and upper ureter in 2 cases. Sixteen cases (52%) became stone-free and residual stones (less than or equal to 4 mm) remained in 9 cases (overall effective rate 81%) at one month after the treatment. There were no serious complications including bacteremia and renal hematoma. We concluded that Therasonic lithotripter is useful in the management of upper urinary tract calculi.
Asunto(s)
Litotricia/instrumentación , Cálculos Urinarios/terapia , Adulto , Anciano , Femenino , Fiebre/etiología , Humanos , Cálculos Renales/terapia , Litotricia/efectos adversos , Masculino , Persona de Mediana Edad , Cálculos Ureterales/terapiaRESUMEN
The AMS 700TM & 700 CXTM penile prosthesis was implanted in 34 organic and mixed-type impotent patients between November, 1984 and July, 1988. The patients' ages ranged between 32 and 70, with an average age of 57.2. Twelve weeks after implantation, the prosthesis was evaluated in terms of patient satisfaction with sexual intercourse and postoperative complications. Twenty three patients (67.7%) were highly satisfied, 7 (20.3%) satisfied, 3 (8.8%) dissatisfied and 1 patient worsened (2.9%). Severe complication was found in two cases, both of them being complicated by infection; as a result the prosthesis was removed. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 26 cases (76.5%), moderate utility in 7 cases (20.6%), and no favorable in one case (2.9%). Thus, overall effectiveness and safety of the AMS 700 penile prosthesis, with its excellent cosmetic appearance upon implantation, were demonstrated by the above findings.