[Infective endocarditis with the fistula from sinus Valsalva to right atrium and ventricle; report of a case].

A 77-year-old man complained general fatigue and fever. Preoperative echocardiography revealed vegetation of aortic valve, abnormal shunt flow from the sinus of Valsalva was detected in the right atrium and ventricle without perivalvular abscess cavity or aneurysm of the sinus of Valsalva. He diagnosed aortic valve endocarditis with aorto-right atrium and ventricle fistula. He received aortic valve replacement and patch closure at the sinus of Valsalva using the pericardium. Residural aortic-right atrium and ventricle shunt was not detected after the operation, the post operative course was uneventful without congestive heart failure nor signs of infection.

[Large coronary aneurysm after coronary intervention for acute myocardial infarction; report of a case].

A 59-year-old man was admitted to our hospital because of angina pectoris and a large right coronary aneurysm. Two years previously, he underwent percutaneous coronary balloon angioplasty for a stenotic lesion in right coronary artery (RCA) #3. Angiography and computed tomography showed a large right coronary aneurysm. On-pump coronary artery bypass grafting (CABG), ligation of RCA proximal and distal to the aneurysm, resection of the aneurysm was performed successfully. Postoperative course was uneventful with satisfactory angiographic results.

[Perforation due to new myocardial infarction long time; report of a case].

A 65-year-old man was admitted to the hospital because of effort chest pain, 8 years after he received coronary artery bypass grafting [CABG: left internal thoracic artery (LITA) to left anterior descending artery (LAD), saphenous vein graft (SVG) to first diagonal branch (D1) and SVG to postero-lateral branch (PL)]. Emergent coronary angiography revealed right coronary artery occlusion with well patent bypass grafts. Percutaneus coronary intervention (PCI) was performed successfully, but 9 hours later, ventricular septal perforation (VSP) was occurred. Swan-Ganz catheter revealed that pulmonary to systemic blood flow ratio (Qp/Qs) was 2.6. In spite of intensive medical care, his hemodynamics was gradually exacerbated. Subsequent intracavitary repair with equine pericardial patch, sutured using interrupted mattress sutures with felt pledgets, was performed. He had an uneventful recovery thereafter, extubated and weaned from an intra-aortic balloon pumping at the 1st day. He was discharged from hospital on the 27th postoperative day.

[Endovascular stent-grafting for mycotic thoracic aortic aneurysm].

We report 3 cases of endovascular stent-grafting (ESG) for mycotic thoracic aortic aneurysm. The case 1 was a rupture of pseudoaneurysm of the descending aorta caused by mediastinitis due to perforation of esophageal ulcer. The patient underwent emergent ESG for temporary control of the rupture. He underwent esophagus reconstruction 5 month after ESG. The case 2 was admitted due to inflammatory reaction. She was diagnosed with mycotic descending aortic aneurysm and underwent elective ESG because of her old age. Her postoperative course was uneventful and no infection recurred. The case 3 underwent ESG for a ruptured mycotic descending aortic aneurysm. But 113 days after ESG, he underwent ESG again for a ruptured endoleak of the stentgraft. His blood culture demonstrated methillin-resistant Staphylococcus aureus (MRSA). He died of rupture to bronchus and esophagus at 18th day after ESG. We believe that ESG is useful in high risk patients for temporary management of the rupture.

[Aortic dissection and annulo-aortic ectasia complicating systemic lupus erythematousus; report of a case].

A 31-year-old man with systemic lupus erythematosus had received long term steroid therapy. He had no compliant, but magnetic resonance imaging showed aortic dissection and annulo-aortic ectasia. Echocardiogram showed severe aortic regurgitation. Therefore aortic root replacement was performed. A histological study of the aortic wall demonstrated myxomatous degeneration in the media. He recovered uneventfully, except for receiving continious hemodia filtration during 4 days after the operation

[Management of quadruple valves for severe infective endocarditis; report of a case].

A 74-year-old man had pustulant bilateral arthritis complicated with sepsis and disseminated intravascular coagulation (DIC). Microbiologic study of blood sample showed Streptococcus and methicillin resistant Staphylococcus aureus (MRSA). He was complicated with postulant diskitis since then. Medical treatment for DIC and administration of antibiotics were performed. Preoperative echocardiography revealed massive aortic regurgitation and vegetation of aortic valve, moderate pulmonary regurgitation and vegetation of pulmonary valve, massive mitral regurgitation, massive tricuspid regurgitation. He was diagnosed as infective quadruple valve endocarditis. He received aortic valve replacement, pulmonary valve replacement, mitral valve repair and tricuspid valve repair. Postoperative echocardiography showed satisfactory function of bioprosthesis. Postoperative course was uneventful.

[Successful consecutive seven time's surgical repair of Marfan syndrome].

We report a patient with Marfan syndrome who received successful 7 consecutive operations during 11 years. She underwent descending aortic replacement for chronic type B dissection at the age of 24. Mitral valve replacement (MVR) was performed for mitral regurgitation (MR) at the age of 30, and abdominal aortic replacement was done for persistent dissection at the age of 31, aortic root and arch replacement was done at the age of 34. The 9 months later, she received re-MVR for dysfunction of bioprosthesis and tricuspid valve anuloplasty (TAP) for tricuspid regurgitation (TR). But severe paravalvuler leakage of mitral valve necessitated direct closure of detachment. Thoracoabdominal replacement was performed for rupture of persistent dissection at the age of 35. She was discharged on the 54th day after the 7th surgery.

Extracellular ATP itself elicits superoxide generation in guinea pig peritoneal macrophages.

Extracellular ATP itself elicited the generation of superoxide (O2-) in guinea pig peritoneal macrophages associated with an increase in cytosolic calcium ([Ca2+]i). The ATP-induced O2- generation was completely inhibited by pretreatment with pertussis toxin (PT) accompanied by the suppression of [Ca2+]i mobilization. Pre-exposure to a small amount of phorbol myristate acetate (PMA) primed the ATP-induced generation of O2- without a change of [Ca2+]i. The results suggest that ATP-induced O2- generation is mediated by [Ca2+]i mobilization and by PT-sensitive G protein.

Juberg-Marsidi syndrome: report of an additional case.

We report on a 2-year-old boy with Juberg-Marsidi syndrome. He has mental retardation, short stature, micropenis, cryptorchidism, and minor facial abnormalities. His Leydig cells responded to the administration of human chorionic gonadotropin and there were positive responses of LH and FSH to the administration of LH-RH. He showed normal weight gain and head circumference which have not been described previously. The association of Juberg-Marsidi syndrome with HbH disease was ruled out in the propositus.

The treatment of obstructive azoospermia in male infertility--past, present, and future.

Until recently, the primary treatment option for infertile men with obstructive azoospermia was the reconstruction of the male seminal tract when the causes of obstruction were reconstructable. For unreconstructable causes, such as congenital absence of the vas deferens, the primary treatment option involved implantation of an alloplastic artificial spermatocele for subsequent percutaneous retrieval of sperm. Retrieved sperm was then used for intrauterine insemination. The introduction of in vitro fertilization (IVF), performed together with microsurgical epididymal sperm aspiration (MESA), provided new frontiers for the treatment of unreconstructable obstructive azoospermic infertility in men. Against this background, the author reviewed the past and present status of the treatment of obstructive male infertility for the purpose of seeking a future course for the treatment of obstructive azoospermia. At the Andrology Clinic, 246 (26%) of 963 infertile males revealed azoospermia and 72 (29%) of these 246 patients showed obstruction at the seminal tract, showing that 7.5% of male infertility cases were caused by ductal obstruction. Microsurgical reconstruction of the seminal tract was performed, including vasovasostomy (29 cases), epididymovasostomy (18 cases), and artificial spermatocele implantation (20 cases). Vasovasostomy resulted in an 81.3% patency rate and a 37.5% fertility rate. Epididymovasostomy showed a 71% patency rate and a 29% fertility rate. In contrast, artificial spermatocele implantation resulted in positive sperm present in the aspirated fluid in 33.3% of the patients; however, no pregnancy was achieved by artificial insemination using aspirated sperm. MESA together with assisted reproductive technology (ART) in 14 patients showed 79% ovum fertilization rates and a 35.7% clinical pregnancy rate. Thus, this new technique could open new frontiers for the future treatment of obstruction of the male seminal tract which cannot be reconstructed by vasovasostomy or vasoepididymostomy.

Effect of low-dose androgen and zinc sulfate on sperm motility and seminal zinc levels in infertile men.

Beneficial effects of zinc therapy in some infertile patients with low seminal zinc concentrations and decreased sperm motility have been reported recently. The effects of zinc therapy, low-dose (5-10 mg/day) androgen therapy, and combination therapy of both zinc and low-dose androgen, on sperm motility and seminal zinc concentration were studied in patients referred to the andrology clinic. Low-dose androgen therapy increased seminal zinc concentrations and sperm motility, only when pretreatment seminal zinc concentrations were low. Furthermore, patients with low seminal zinc concentrations and poor sperm motility showed greater improvement of sperm motility and seminal zinc levels in response to zinc sulfate with fluoxymesterone than did fluoxymesterone alone or zinc sulfate alone, possible due to a synergistic effect of zinc and androgen.

Zinc sulfate therapy for infertile male with or without varicocelectomy.

One hundred one men were treated for infertility with 440 mg of zinc sulfate daily for sixty days to two years. All subjects demonstrated low seminal plasma zinc concentrations prior to treatment. Patients were divided into two groups: group [Zn], 65 subjects who underwent zinc therapy alone and group [Var/Zn], 36 subjects who received zinc sulfate therapy after varicocelectomy. In both groups seminal zinc levels were significantly higher (P less than 0.05 and P less than 0.01, respectively) two months after the initiation of zinc therapy. There were no significant changes in sperm count or motility for the [Zn] patients. However, group [Var/Zn] showed a significant increase (P less than 0.05) of sperm motility at two months and twelve months after starting zinc sulfate therapy. We separated the [Var/Zn] patients into two sub-divisions: those who impregnated their wives after therapy, and those who remained infertile despite treatment. Only those patients who impregnated their wives showed a significant (P less than 0.05) increase in sperm motility two months after the initiation of zinc therapy. Those patients of the [Var/Zn] group who remained infertile despite treatment showed a significant increase (P less than 0.05) in sperm motility after twelve months of therapy. Of the [Zn] patients 27.7 per cent (18) successfully impregnated their wives, while the [Var/Zn] patients exhibited a pregnancy rate of 50 per cent (18 patients). These data indicate that zinc sulfate therapy for patients with low seminal zinc concentrations may be an effective treatment for infertile patients especially after varicocelectomy.

Castleman disease. Unusual retroperitoneal location indistinguishable from malignant tumor in preoperative angiographic appearance.

Castleman disease (angiofollicular lymph node hyperplasia) has been reported rarely as a solitary retroperitoneal mass radiographically indistinguishable from retroperitoneal malignancies. We report a case of a hyaline-vascular variant of Castleman disease presenting as a pararenal mass. The computerized tomographic and angiographic appearances of this lesion are presented, and the clinical importance of the differential diagnosis of retroperitoneal tumors is discussed.

Testicular development following unilateral orchiopexy measured by a new orchiometer.

Of 170 patients having undergone orchiopexy for unilateral cryptorchid testes, 90 responded to our inquiry. Testicular size was measured in 55 patients using an accurate and practical orchiometer (punched-out orchiometer) developed in our department. In boys under ten years of age (prepubertal), testicular development was minimal, and the operated on and contralateral testes were not significantly different. With the onset of puberty, both testes enlarged, and no significant differences were observed. However, by age fourteen the side operated on was significantly (p less than 0.05) less well developed than the contralateral testis. No difference was detected clinically between the operated on and contralateral testes when the contralateral testis was less than 10 mL in volume. When the contralateral testis was greater than 15 mL, however, a significant difference was detected both statistically (p less than 0.05) and clinically. The findings suggest limited prospects for the development of testes that are operated on at puberty.

The application of intrascrotal deep body temperature measurement for the noninvasive diagnosis of varicoceles.

The authors used intrascrotal deep body (intratesticular) temperature measurement in an attempt to make the diagnosis of varicoceles more objective. Two hundred five male patients complaining of infertility were classified into three groups: group A consisted of 84 patients with varicocele; group B of 66 patients without varicocele; and group C of 55 patients after varicocelectomy. The bilateral intrascrotal temperatures were recorded in the supine position and then monitored continuously in the standing position. The maximum temperatures in both positions were compared between each group. The mean temperature of the varicocele group was higher than that of the other two groups in the standing position. The authors studied the difference in temperature (delta T) due to postural change from supine to standing. The mean delta T of the left testis was +0.78 degrees C in the varicocele group, whereas it was approximately -0.5 degrees C in the other two groups. The authors conclude that deep body temperature provides a practical index of the intrascrotal temperature and is useful as one of the objective, clinical criteria for the diagnosis of varicocele.

Significance of testicular size measurement in andrology. I. A new orchiometer and its clinical application.

When performing a physical examination in the andrology clinic, accurate measurement of testicular size is important. Two methods for measuring testicular size have been developed using calipers for measurement and comparison with plastic testicular models. We have developed a new orchiometer, which consists of a graded series of punched-out elliptical rings with the volume of the ellipsoids indicated on each ring. Testicular sizes measured by our orchiometer had a better correlation with real testicular size determined by water displacement of testes after castration when compared with those data obtained by using calipers. By the use of this orchiometer, the normal range of the adult testicular size was greater than 14 ml in Japan and greater than 17 ml in the United States. This orchiometer is valuable for the rapid and accurate assessment of sexual maturation in children and men.

Regulation of rat caput epididymidis contractility by prostaglandins.

Mechanical activity of the rat caput epididymidis in vitro was recorded using a videomicrography system. The effects of prostaglandin (PG)F2 alpha, PGE2, and aspirin on caput epididymidis contractility were determined by measuring the frequency of contraction, luminal diameter, and amplitude of contraction at various concentrations of each test compound in vitro. PGF2 alpha stimulated contractility of the tubules at physiological concentrations, while PGE2 reduced contractility. Aspirin strongly inhibited contractility at concentrations of 10(-3) and 10(-2)M. Endogenous levels of PGF2 alpha and PGE were determined for rat testes, caput, corpus, and cauda epididymidis and vas deferens. While the concentrations of PGE were consistently higher than those of PGF2 alpha, both compounds were relatively low in the testes, high in the vas deferens, and intermediate throughout the epididymis. Results from these experiments strongly suggest that PGs are important regulators of proximal epididymidis contractions and thus may regulate sperm transport through that organ.

Syosaiko-to and saiboku-to (Chinese-Japanese herbal medicine) suppress the release of arachidonic acid metabolites from cultured porcine pulmonary artery endothelial cells.

The influences of Syosaiko-to and Saiboku-to, traditional Chinese-Japanese medicines, on the arachidonic acid metabolism of porcine pulmonary artery endothelial cells (PPAEC) in culture were investigated. 6-keto-PGF1 alpha, a stable end product of prostacyclin, released by PPAEC during a 48 h incubation period with 1000 micrograms/ml of Syosaiko-to or Saiboku-to was significantly decreased. Analysis of the eicosanoid profile by high performance liquid chromatography revealed that both cyclooxygenase and lipoxygenase derivatives were released in smaller than usual proportions from PPAEC during 24 h incubation periods with 500 micrograms/ml of Syosaiko-to or Saiboku-to. Clinically, Syosaiko-to is used for chronic hepatitis and Saiboku-to is prescribed for bronchial asthma. The experimental findings could explain the anti-inflammatory effect of Syosaiko-to and Saiboku-to from the perspective of their influences on arachidonic acid metabolic activity associated with PPAEC.

Quantitative analysis of testicular interstitial fibrosis after vasectomy in humans.

PURPOSE: Germ cell differentiation, DNA synthesis, and apoptosis can be evaluated quantitatively. On the other hand, an interstitial lesion is difficult to examine. We have focused on the quantitative analysis of testicular interstitial fibrosis after vasectomy. MATERIALS AND METHODS: Forty testicular biopsy specimens from twenty consecutive men were obtained at vasovasostomy. Johnsen's mean score was calculated from testicular biopsy specimens. Percent of interstitial fibrosis was determined quantitatively by the NIH-Image after Masson-trichrome staining. RESULTS: A significant increase in interstitial fibrosis was observed along with the obstructive interval (p < 0.001). Johnsen's mean score count did not associate with the obstructive interval. CONCLUSION: Interstitial lesions of testicular physiology and pathophysiology can be evaluated using the NIH-Image. Interstitial fibrosis, but not the intraseminiferous status, reflects the irreversible damage of vasectomized testes.

[Two cases of ectopic ureterocele in female adults diagnosed by the growth of stones in the cele].

We report two cases of stones in the ureterocele in female adults. In case 1 a 31-year-old woman was hospitalized with pollakisuria and cloudy urine. In case 2 a 51-year-old woman's chief complaint was discomfort after urination. They had had no previous symptoms. The growth of stones in the ureterocele caused the symptoms which led to the diagnosis of ectopic ureterocele.