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A 93-year-old man with a femoral fracture was admitted to the emergency department. The patient presented with severe hypoxemia and shock. Enhanced computed tomography confirmed deep venous thrombosis in the left leg and pulmonary embolism. Subsequently, an inferior vena cava filter (IVCF) was implanted. Although the IVCF was completely unsheathed for deployment, it remained fully folded and did not open; it was not deployed or retrieved. A new IVCF was successfully placed in the same position. Acute treatment for the deep venous thrombosis and further pulmonary embolism was achieved.

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OBJECTIVE: To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. METHODS: We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. RESULTS: VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. CONCLUSION: The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.

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OBJECTIVES: To clarify the efficacy of low-intensity extracorporeal shockwave therapy for patients with erectile dysfunction, compare the efficacy between two types of lithotripters (ED1000 [focused type] and Renova [linear type]), and detect factors indicative of therapeutic gain with the treatment. METHODS: This retrospective study included 76 patients (52.8 ± 11.7 years) treated by ED1000 (12 times over 9 weeks) and 484 patients (52.5 ± 11.6 years) treated by Renova (4 times over 4 weeks). Age, sexual symptoms scores, and blood examinations were assessed. Efficacy was judged by improvement of the scores and patient satisfaction and compared between patients at 1 month after treatment with the lithotripters. Independent factors influencing efficacy by Renova were also assessed. RESULTS: Sexual symptom scores were improved significantly by both lithotripters, although the changes in the scores did not differ significantly between them. Efficacy rate as judged by patient satisfaction was 65.8% with the ED1000 and 71.1% with Renova, also without significant difference. Among several factors including age, sexual symptoms scores, endocrinological factors, metabolic factors, and the rate of phosphodiesterase type 5 inhibitor use, only age was found to be an independent factor influencing the efficacy of Renova. CONCLUSION: We clearly showed the high efficacy of both lithotripters. Although the efficacy rate did not differ between them, we speculated that the fewer treatment sessions needed with the Renova versus the ED1000 would be a great advantage for patients. We also suggest that Renova should be recommended for patients younger than 70 years of age.

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BACKGROUND: Thrombophilia causes thrombosis after kidney transplantation (KT). Protein C deficiency is a rare form of hereditary thrombophilia. To our knowledge, there are few reports on KT for patients with protein C deficiency, and there are no reports of KT in patients with protein C deficiency administered with activated protein C concentrate. METHOD: Here we reported the case of a patient with protein C deficiency who underwent KT without the occurrence of any fresh thrombosis after administration of an activated protein C concentrate. The patients was a 49-year-old woman diagnosed with immunoglobulin A nephropathy at 20 years of age. During pregnancy, she experienced deep vein thrombosis of the lower extremities and pulmonary embolism for which she was started on warfarin. After a thorough examination, the patient was diagnosed with protein C deficiency. The patient had end-stage kidney disease and received a preemptive living donor kidney transplant from her mother. RESULTS: To prevent thrombosis, we switched from oral warfarin to continuous heparin 7 days before surgery. Heparin was discontinued 6 hours before surgery, and continuous activated protein C concentrate was administered 12 hours before surgery. Heparin administration was resumed 6 hours after the surgery. Warfarin administration was restarted 3 days after the surgery, and heparin was discontinued 11 days post-surgery. The surgery was performed without complications. After the KT, the patient's renal function steadily improved, and no fresh thrombosis were observed. CONCLUSIONS: Thrombosis can cause graft loss and pulmonary embolism, thus appropriate administration of activated protein C concentrate may help prevent thrombosis.

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OBJECTIVES: To investigate the efficacy of tadalafil for patients with benign prostatic hyperplasia and chronic prostatitis/chronic pelvic pain syndrome. METHODS: Tadalafil 5 mg was given each morning for 12 weeks to patients diagnosed as having either moderate or severe lower urinary tract symptoms. Voiding symptoms were compared between patients with a high (≥4; high group) and low (<4; low group) pain subscore of the National Institutes of Health Chronic Prostatitis Symptom Index before and after tadalafil administration. The correlation between changes in the Chronic Prostatitis Symptom Index and the International Prostate Symptom Score during treatment was also investigated. RESULTS: At baseline, the pain subscore of the Chronic Prostatitis Symptom Index was high (≥4) in 24 of 74 (32.4%) patients. The International Prostate Symptom Score in the group with a high pain subscore was significantly higher than that in the group with a low pain subscore. International Prostate Symptom Score, National Institutes of Health Chronic Prostatitis Symptom Index total score and pain subscore were all significantly improved after treatment. The change in the Chronic Prostatitis Symptom Index total score correlated positively with the change in the International Prostate Symptom Score. The decrease in the International Prostate Symptom Score was significantly greater in the group with high versus low pain subscore. CONCLUSIONS: Tadalafil is sufficiently effective in the treatment of patients with benign prostatic hyperplasia and severe chronic prostatitis/chronic pelvic pain syndrome.

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