Laparoscopic adrenalectomy for pheochromocytoma: a literature review.

Laparoscopic adrenalectomy has become the standard treatment for benign adrenal tumors, providing minimal invasiveness and early recovery. In the case of pheochromocytomas, special attention should be paid perioperatively to prevent excessive hypertension or hypotension. The protocol should include sufficient preoperative medication with alpha 1 blockers, early ligation of the adrenal vein, and minimal handling of the tumor itself. A literature review of 227 laparoscopic adrenalectomies for pheochromocytomas revealed that the perioperative data, including the operative time, blood loss, and hemodynamic status, were similar or slightly better in the laparoscopic procedures as compared to the open procedures, although the convalescence period was significantly shorter in the laparoscopic surgery. The majority of surgeons prefer the transperitoneal approach for pheochromocytomas, although some authors use the retroperitoneal approach successfully. A comparison of the perioperative data from laparoscopic surgeries for pheochromocytomas versus those for other adrenal tumors showed that the former had slightly higher demands to complete the procedure safely. In the treatment of familial pheochromocytoma due to multiple endocrine neoplasia type 2 or von Hippel-Lindau disease, a cortical-sparing adrenalectomy can be safely performed laparoscopically. In conclusion, laparoscopic adrenalectomy is the standard for small pheochromocytomas, with a high success rate when the procedure is performed by experienced surgeons.

[Transperitoneal laparoscopic radical prostatectomy with the Montsouris technique: experience in initial 5 cases].

PURPOSE: In 1998 Guillonneau et al reported feasible and safe technique for laparoscopic radical prostatectomy. Herein we review initial 5 cases with using the Montsouris technique. MATERIALS AND METHODS: Between January and April 2000, 5 patients underwent transperitoneal laparoscopic radical prostatectomy. Clinical stages were T1c in 2, T2a in 1 and T2b in 2 patients. Preoperative PSA levels and Gleason grades in needle biopsies ranged from 7.9 to 39 ng/ml and from 2 to 6, respectively. Under general anesthesia 5 to 6 trocars were introduced and the patient was placed in the exaggerated Trendelenburg position. In 2 patients bilateral obturator lymph nodes were dissected for frozen pathological examination. Antegrade prostatectomy was performed initiating with the transperitoneal dissection of seminal vesicles. A watertight vesicourethral anastomosis was made with 8 to 10 interrupted sutures. RESULTS: Operating time and blood loss ranged from 505 to 925 minutes and from 100 to 700 gm, respectively. There were no intraoperative complications and one postoperative complication of prolonged urinary leakage, which was spontaneously closed. In other 4 patients Foley catheters were removed on postoperative day 6 to 10. CONCLUSIONS: Laparoscopic radical prostatectomy provides better visualization, inducing meticulous surgical procedures and less blood loss. More sophisticated maneuver would be required in dissection between the prostate and the bladder neck.

Transperitoneal anterior laparoscopic adrenalectomy: the easiest technique.

Four laparoscopic methods have been developed to approach the adrenal gland: anterior or lateral transperitoneal approaches, and lateral or posterior retroperitoneal approaches. The advantages and disadvantages of these methods were reviewed during a workshop held by the Japanese Society of Endourology and ESWL in 1997. The transperitoneal anterior approach, when combined with a lateral approach for the left side, is the easiest for small adrenal tumors, and discloses the adrenal vein early in the procedure. For large tumors over 5 cm in diameter, the transperitoneal lateral approach is the most feasible bilaterally. Regardless of the methods of approach, laparoscopic adrenalectomy has already become the standard procedure for adrenal tumors, because it minimizes the operative morbidity and postoperative hospital stay.

[Efficacy of single-dose therapy with levofloxacin for acute cystitis: comparison to three-day therapy].

To investigate the safety, efficacy and recurrence-inhibiting effect of a single dose of levofloxacin (LVFX) for the treatment of acute uncomplicated cystitis in women, 56 females with acute uncomplicated cystitis between 17 and 73 years old were studied, based on the urinary tract infection (UTI) drug efficacy evaluation. The patients were divided into two groups; in Group A a single 200 mg dose of LVFX was administered, while in Group B, 100 mg of LVFX was administered twice a day for three days. The patients were re-examined three days later. The presence or absence of recurrence was surveyed by a questionnaire 3 months after the treatment. The efficacy rate on the third day after the administration in Group A and Group B was 96.9% (32 cases) and 95.8% (24 cases), respectively, and the recurrence rate within three months after administration 17.4% (4 in 23 cases) and 5.6% (1 in 18 cases), respectively. As for adverse drug reaction, abdominal pain was seen in one case, without a clear cause-effect relationship. Although the number of cases studied was small, no significant difference was seen between the single dose group and 3-day dose group in the safety, efficacy and recurrence-inhibiting effect of the new quinolone antibacterial treatment for acute uncomplicated cystitis in women, confirming the usefulness of the single dose treatment.

[Clinical statistics on in-patients and operations during a 20-year period (1975-1994) at Department of Urology, Kansai Medical University].

The patients, diseases and operations experienced between 1975 and 1994 in our department were statistically analyzed. The numbers of in-patients and operations have been increasing since 1977. During these 20 years, endoscopic surgery has replaced many open surgical procedures. The introduction of extracorporeal shock wave lithotripsy has dramatically changed the therapeutic modality for urolithiasis, and decreased of the necessity of open surgery.

[Early recovery from locked-in syndrome due to brain infarction in a young patient with hypoplasia of bilateral vertebral arteries and a persistence of primitive trigeminal artery].

A 36-year-old man was admitted to Kanto Chuo Hospital because of hearing loss and dysphagia. On admission physical and neurological findings revealed obesity, hypertension, nystagmus, right hearing loss, dysarthria, and dysphagia. Routine laboratory findings disclosed leukocytosis, liver dysfunction, hypercholesterolemia, proteinuria, and glucosuria. Immunological, coagulopathic, and endocrinological findings, electrocardiogram, echocardiogram, and brain CT scan were unremarkable. He was diagnosed as brainstem infarction, and then conservative therapies were begun. Seven hours after admission, he suddenly fell into coma and apneutic state, requiring artificial ventilation. The next day he was fully conscious, but could'nt make any voluntary movements except for vertical eye movements, suggesting locked-in syndrome (LIS). Brain MRI showed infarction of pons, medulla oblongata, and right cerebellum. Cerebral angiography revealed hypoplasia of bilateral vertebral arteries, a persistence of right primitive trigeminal artery (PTA), and retrograde blood flow of basilar artery from the PTA. Then he made a rapid recovery, and on 80th day he was discharged only with right hearing disturbance and mild left cerebellar sign. We speculated that hypoplasia of the bilateral vertebral arteries caused the brain infarction, and that back flow of the basilar artery from the PTA, in part, contributed to the early recovery from the LIS.

Analysis of mouse hemoglobin alpha-chain locus mutation induced by N-ethyl-N-nitrosourea.

In a mouse specific-locus test in stem-cell spermatogonia of mice after treatment with N-ethyl-N-nitrosourea (ENU), a mutation at the hemoglobin alpha-chain locus was obtained. In an original mutant, the mutation was detected as a change in band density using cellulose acetate electrophoresis, e.g. the slow moving band was much higher than that of normal F1 mice. Yet, migration of the mouse bands was similar. In isoelectric focusing, the migration of a band toward cathode was observed, indicating that the variant hemoglobin is caused by mutation at an alpha-globin chain. This mutation was found to be heritable and viable in homozygous condition from a genetic test on the mutant, suggesting that this mutation would be due to a base-pair change. According to the usual nomenclature of mutation at the hemoglobin locus, the allele symbol of this mutation was tentatively designated as Hbacc3.

The induction of recessive mutations in mouse primordial germ cells with N-ethyl-N-nitrosourea.

A specific-locus test was carried out to examine the mutagenic activity of N-ethyl-N-nitrosourea (ENU) on mouse primordial germ cells (PGC). Embryos of C3H/He mice were treated transplacentally with 30 or 50 mg ENU per kg of maternal body weight on day 8.5, 10.5, or 13.5 of gestation (G8.5 day, G10.5 day, or G13.5 day). Male and female mice that had been treated with ENU in embryonic stages were mated with female or male tester PW mice to detect recessive mutations induced in PGC. ENU induced recessive mutations at a relatively high rate in PGC at these developmental stages. The most sensitive stage was G10.5 day. On G8.5 day, the induced mutation rate in males and females was not significantly different. Cluster mutations, which originate from the limited number of PGC and cell killing, were more frequently induced at an earlier developmental stage. The induced mutation rate per unit dose of ENU (1 mg/kg) was higher in G8.5 and G10.5 day PGC than in stem-cell spermatogonia. It can be concluded that mouse PGC are more sensitive than stem-cell spermatogonia to the induction of recessive mutations by ENU.

Surgical management of haemangioblastoma of the posterior fossa.

Fifty-one cases of posterior fossa haemangioblastoma have been seen in our department over a period of 23 years. Seven cases were associated with spinal cord lesions and one with a supratentorial lesion. There were 22 cases of Lindau's disease (43%). The onset was earlier and recurrences commoner than in isolated cases. In 10 cases the development of new tumours in different parts of the central nervous system (CNS) required re-operation, demonstrating the multicentric nature of this disease. The majority of the tumours occupying the fourth ventricle or medulla oblongata (8 cases) were macroscopically solid and had higher post-operative morbidity than the cystic tumours in the cerebellum. The recent development of magnetic resonance imaging (MRI) provides accurate anatomical information of the lesions (especially those of the brain stem and spinal cord) even while asymptomatic. The brilliant enhancement of these tumours on MRI with Gadolinium-diethyline-triamine-pentaacetic acid (Gd-DTPA) has proved to be particularly useful.

[Clinical studies of patients with bladder cancers].

A clinical survey was performed on 185 cases of primary bladder cancer treated at our Department of Urology, between January, 1985 and December, 1989. Clinicopathological profiles of patients and survival rates according to these profiles were investigated. The patients were between 29 and 95 years old. The male to female ratio was 3.1 to 1. The cumulative survival rate after the first treatment was 73.3% and 71.5% at 3 and 5 years, respectively. Histologically, 17 cases were diagnosed as transitional cell carcinoma G1, 69 cases as G2 and 69 cases as G3. 5 cases were diagnosed as stage pTis, 6 cases as pTa, 41 cases as pT1, 15 cases as pT2, 9 cases as pT3a, 14 cases as pT3b and 6 cases as pT4. Stage, grade, size and type of tumors reflected the prognosis well. Significant differences were observed between the survival rates of the patients with grade G2 and grade G3, and the patients with stage T1 and stage T2. Although low-grade low-stage tumors recurred in 44% of the patients. The pathological stage showed a good relation to the grade. In particular, none of the G1 bladder tumors had muscle invasion in our series.

The induction of specific-locus mutations with N-propyl-N-nitrosourea in stem-cell spermatogonia of mice.

A specific-locus test to determine the effect of N-propyl-N-nitrosourea (PNU) on the stem-cell spermatogonia of mice has been performed. Male wild-type mice (C3H/He) were treated with an intraperitoneal injection of 200 mg/kg [corrected] of PNU. Eight weeks after the injections, the males were mated with tester stock females (PW), homozygous for 6 visible recessive genes. Twelve mutants among 8605 offspring were observed. The mutation frequency with PNU was calculated to be 23.2 x 10(-5)/locus/gamete, showing a significant difference from that of the non-treated control. The mutations were all heritable and half of them were viable in homozygous condition. The mutation frequency with PNU was about one-third of that with N-ethyl-N-nitrosourea, a highly potent mutagen for mouse stem-cell spermatogonia.

Surgical management of hemangioblastoma of the spinal cord: a report of 18 cases.

The cases of 18 patients operated on for hemangioblastoma of the spinal cord were reviewed. There were 11 men and 7 women. (M:F = 1.6:1) and in 15 patients, the onset of spinal symptoms was before the age of 40 years. There were 19 intradural and 2 extradural tumors. The tumor was accompanied by a cyst in 9 patients (50%). There were 6 cases of Lindau's disease, including 3 cases of multiple spinal tumors. Symptoms improved postoperatively in 13 patients. were unchanged in 2, and were aggravated in 3. At the present time, magnetic resonance imaging with gadolinium-diethylene-triamine-pentaacetic acid (Gd-DTPA) enhancement is the most useful tool for precise localization of the tumor and differentiation of any accompanying cyst.

HBV-DNA hybridization in hepatocellular carcinoma associated with alcohol in Japan.

To clarify the role of the hepatitis B virus (HBV) in hepatocellular carcinoma (HCC) associated with alcohol consumption, HBV-DNA in the liver of 19 patients with HCC were investigated. HBV-DNA was examined by Southern blot hybridization. HBV-DNA was integrated into tumor cells from five out of six (83%) patients with HCC associated with HBs antigen (HBsAg)-positive post-hepatitic liver cirrhosis (LC), but this was not related to the history of alcohol intake. In 13 HCC patients of HBsAg-negative alcoholic LC, HBV-DNA integration was not detected in any patient. These findings suggest that HBV does not play a major role in the pathogenesis of HCC in HBsAg-negative alcoholics in Japan.

The effect of intravenous lidocaine on experimental brain edema and neural activities.

A series of experiments was conducted to clarify the effect of intravenous administration of lidocaine on brain water content, local cerebral blood flow (lCBF), and neural recovery in brain injury induced by exposure of the cat's cerebral surface to the air. The injury produced ischemia and edema in the cortex and white matter without direct damage of the cortex. Lidocaine (3.0 mg/kg) was given intravenously for 30 minutes immediately after air exposure and thereafter at the rate of 2 mg/kg/hour. Twelve hours after exposure, lidocaine significantly suppressed cortical ischemia and edema; however, it had no effects in the white matter. The electrophysiologic activities of the cortex and white matter which were assessed by the direct cortical response and somatosensory evoked response were significantly preserved by lidocaine compared with nontreated animals. The results of this experiment demonstrate that intravenous lidocaine has a significant beneficial effect on cortical ischemia and electrophysiologic activities of the cortex and white matter in injured brain.

Assessment of reversible cerebral ischaemia in man: intraoperative monitoring of the somatosensory evoked response.

Central conduction time (CCT) has been monitored in 37 patients undergoing temporary arterial occlusion in aneurysm surgery. 17 patients had internal carotid, 17 had middle cerebral, and 4 had basilar artery occlusion. Internal carotid or middle cerebral artery occlusion lasting less than 12 minutes has not been associated with postoperative morbidity, in any case without appreciable change in CCT after occlusion. Prompt prolongation of CCT was warned the surgeon, but CCT prolongation up to 10 ms could occur without permanent neurological deficit, except in one Grade 4 patient. 10 of 18 patients who lost the N 20 cortical potential showed postoperative neurological deficit, which was promptly recoverable in 7 patients. The speed of loss or recovery of N 20 enabled a patients's prognosis to be predicted. Irrecoverable postoperative deficit is unlikely if the N 20 takes longer than 4 minutes to disappear, to reappears within 20 minutes after recirculation.

[The effect of lidocaine on brain edema and neural function].

Recently lidocaine (Ld) has been reported to have beneficial effects on neural suppression caused by experimental cerebral ischemia or spinal cord injury. In this paper, the effects of Ld on brain edema, local cerebral blood flow (lCBF), and neural function in the thalamocortical and cortical structures were experimentally studied. Vasogenic brain edema was induced by exposure of the cat's cerebral surface to the air in the manner of Prados et al. The dura mater over the left cerebral hemisphere was resected, and the brain was exposed to room air for 12 hours. The animals were divided into two groups. In the control group of 31 cats, Ld was not administered. In the treated group of 8 cats, Ld (4.5 mg/kg) was given intravenously immediately after the beginning of the air-exposure and thereafter administered as a drip infusion at the rate of 2 mg/kg/hour. In the untreated group, 12 hours after exposure, the cerebral water content measured by gravimetry in the cortex, white matter and thalamus increased by approximately 1.9, 4.1, 0.7%, respectively, compared to the control values. Local CBF measured by the hydrogen clearance method decreased to about 71, 57 and 56% of the control value, respectively. The latency of the N1 component of the somatosensory evoked response (SER) was prolonged significantly 6 hours after air-exposure. The amplitude of the direct cortical response (DCR) decreased significantly 6 hours after air-exposure, and became approximately 50% of the control 12 hours after exposure.(ABSTRACT TRUNCATED AT 250 WORDS)