A case of aldosterone-producing adrenocortical adenoma associated with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone.

A rare case of aldosterone-producing adrenocortical adenoma with preclinical Cushing's syndrome and hypersecretion of parathyroid hormone (PTH) is described. A 64-year-old male patient had a history of hypertension for two decades and hypokalemia for 4 years. He suffered from left hemiparesis and aphasia due to cerebral hemorrhage, but his appearance was not Cushingoid. His plasma renin activity was below the normal range, while plasma aldosterone concentration was high. They did not respond to furosemide-upright test. His plasma cortisol level in the morning was at the upper limit of the normal range, but it did not show a diurnal rhythm nor was it suppressed by 1 mg and 8 mg of dexamethasone. Computed tomography showed a low density tumor in the right adrenal gland. An adrenal scintigram under dexamethasone treatment revealed an uptake of the tracer on the right side, and plasma aldosterone and cortisol concentrations in the adrenal vein were higher on the right side than on the opposite. The diagnosis of right aldosterone-producing adrenal adenoma with an autonomous production of cortisol was confirmed by right adrenalectomy. Histological findings showed an adenoma consisting mostly of clear cells, but that the nests of compact cells were scattered. Analysis of an extract from the adenoma revealed that the adenoma contained an excess amount of aldosterone and that the cortisol/corticosterone ratio was higher than that of aldosterone-producing adenoma. Both serum calcium and PTH levels remained high one year after adrenalectomy. Ultrasonography revealed the swelling of a parathyroid gland on the left side, indicating the coexistence of an autonomous hyperparathyroidism.

Decreasing hypocomplementemia and membranoproliferative glomerulonephritis in Japan.

The number of patients with membranoproliferative glomerulonephritis(MPGN) diagnosed in our institution and the incidence of hypocomplementemia as determined by school urinary screening programs in Japan were investigated retrospectively. Fifty-seven children were diagnosed as having MPGN between 1974 and 1997. Of these, 13 patients were diagnosed during period 1 (1974-1979) and 25 during period 2 (1980-1985). A decreasing trend was observed during periods 3 (1986-1991) (12 patients) and 4 (1992-1997) (7 patients) compared with period 2 (P<0.05 and P<0.01, respectively). A significant difference was also noted when MPGN was compared between periods 1 and 2 (1974-1985) and periods 3 and 4 (1986-1997) (P<0.01). Serum C3 was measured in 1,282 school children with abnormal urinary findings between 1980 and 1997. Thirty children had hypocomplementemia. The incidence of hypocomplementemia was significantly lower in period 3 (1986-1991) (9 children) and period 4 (1992-1997) (2 children) compared with period 2 (1980-1985) (19 children) (P<0.05 and P<0.01, respectively). New cases of MPGN in our institution and the incidence of hypocomplementemia as determined by school urinary screening programs are decreasing in Japan. The reason for this trend is unknown.

Prognostic value of nucleolar organizer regions in supraglottic carcinoma.

The relationship of nucleolar organizer regions (NORs) to proliferative activity and tumor progression was studied in 16 supraglottic carcinomas. The number of NORs stained by a silver colloid staining method (AgNOR staining method) was determined. The mean AgNOR number tended to be higher (but not significantly so) in poorly differentiated tumors. Moreover as T and N categories and stage of the tumor rose, the AgNOR number also rose, but not significantly. More interestingly, the mean AgNOR number was significantly higher in the presence than in the absence of lymph node metastasis. These studies indicate that the AgNOR number might be of clinical value as a predictor of lymph node metastasis of supraglottic carcinomas.

Nucleolar organizer regions in glottic carcinomas: comparison of DNA cytofluorometry and clinicopathological analysis.

The significance of nucleolar organizer regions (NORs) and nuclear DNA content in 73 glottic carcinomas was assessed for proliferative activity and tumor progression. NORs stained with silver colloid were counted, and nuclear DNA content was assayed by cytofluorometry. The cytofluorometric study demonstrated that the percentage of tumors with aneuploidy tended to increase as histological differentiation decreased. Survival rates of patients with diploid and aneuploid tumors were not significantly different. AgNOR staining revealed that mean AgNOR numbers rose as histological differentiation of tumors decreased. Moreover, as T and N categories and stages showed advancing malignancy, mean AgNOR numbers tended to rise. However, there was no significant difference in survival rates between tumors with low and with high AgNOR counts. These studies indicate that while AgNOR staining is better than DNA cytofluorometry for determining histological differentiation of glottic carcinoma, neither is of prognostic value at the present time.

Tracheo-esophageal shunt speech: report of an unusual case.

A rare case of laryngectomee who acquired TE shunt speech is reported. Our patient was a 64-year-old woman with laryngeal cancer (glottic type T3N0M0). She underwent laryngectomy in 1990, and a Komorn tracheo-esophageal shunt operation was performed simultaneously. A voice prosthesis (BIVONA) was inserted into the shunt, but the voice valve was not used. She acquired shunt speech soon after the operation, and there was no need to close the tracheostoma during phonation. Fiberoptic, X-ray and aerodynamic findings of the shunt and esophagus were as follows: (i) The one-way valve of the voice prosthesis was open during inspiration and closed during phonation. (ii) Swallowing of air, as seen in esophageal speech, was not observed. (iii) The neoglottis was in the upper part of the esophagus. It was concluded that the air for the vibration of the neoglottis entered the esophagus through the T-E shunt during inspiration.

Nucleolar organizer regions in adenoid cystic carcinoma of the salivary glands.

In this study of proliferative activity of adenoid cystic carcinomas (ACCs) with different histological patterns, the argyrophilic staining method of nucleolar organizer regions (AgNORs) was applied to paraffin sections from 25 tumors. Sixteen of the neoplasms showed a mixture of different histological patterns in the same section. The AgNOR numbers in the different histological pattern areas in the same tissue sections of all 16 tumors were lowest in the cribriform, intermediate in the trabecular, and highest in the solid pattern areas. The mean AgNOR number was highest in the solid pattern (3.33 +/- 0.52), and lowest in the cribriform pattern (2.12 +/- 0.43). The results show the order of proliferative activity in the different histological pattern areas of ACC, and explain the previous clinical finding that the prognosis of ACC is poorest in solid pattern ACCs. AgNOR staining appears to be a useful technique for evaluation of the proliferative activity of each histological pattern area of ACC, especially when there are different histological pattern areas in the same tissue section.

[Cytofluorometric DNA analysis in different histological patterns of thyroid papillary carcinoma].

Some papillary carcinomas of thyroid glands contain not only typical papillary structures but also various histological features in the same tumor. To investigate how areas with variable histological features differ in proliferative activity and how these differences influence the biological behavior of the whole tumor, we measured DNA contents by cytofluorometry in six papillary carcinomas with different histological features in the same tumor. DNA ploidy patterns were determined and the percentage of S plus G2M phase cells (S + G2M fraction) was calculated only in diploid tumors to assess the proliferative activity. The following conclusions were drawn. 1) It was demonstrated that there were differences in proliferative activity among areas with variable histological features in 4 of six tumors. 2) In the tumors which invaded adjacent tissues, the proliferative activity of the invasive area tended to be higher than that of the original area of the tumor. Therefore, the possibility exists that more precise evaluation of the biological behavior of the tumor can be obtained by measuring DNA contents of the tumor cells in invasive areas. 3) There was the gap in S + G2M fractions among some tumors with the same histological differentiation. Accordingly, DNA analysis of tumors would be of value in estimating proliferative activity.

[Percutaneous renal cyst puncture with CO2 instillation therapy].

Ultrasound-guided percutaneous puncture of renal cysts replaced by CO2 was performed on 9 renal cysts of 6 patients from May 1993 through September 1993. Puncture and aspiration of cysts was performed using a 5.5 Fr one-step fluid drain kit (pig tail stent) under ultrasonography inspection. Aspirated volume of cyst contents was 15-292ml (mean 115 ml), and the instilled CO2 volume was 15-150 ml (mean 73 ml). All patients were checked by CT scan. In one month, the reduction rate of cyst volume was 46-84% (mean 69%) and lumbago, their chief complaint, was improved in all patients. No complications were observed in patients treated by CO2 instillation. Although long-term followup is needed to draw a definite conclusion, this therapy may be useful for benign renal cystic lesions.

[Effect of recombinant atrial natriuretic peptide (r-ANP) on ischemic and cyclosporine-induced kidney damage in rats].

Cyclosporine A (CYA) a new immunosuppressive drug, has greatly improved the outcome of solid graft transplantation. The nephrotoxicity of CYA, however, is a serious problem, and constitutes the major obstacle limiting the use of CYA as an immunosuppressive agent for renal transplantation. On the other hand, the newly described atrial natriuretic peptide (ANP) hormonal system in both humans and animals appears to play an important role in sodium and water excretion. The present study examined the nephrotoxicity of CYA and the effect of recombinant-ANP (r-ANP) on the damaged kidneys in three groups. Group 1 consisted of rats with 45 minutes warm ischemic left kidney and right nephrectomy [WI rats]; Group 2 consisted of WI rats with oral administration of CYA (100mg/kg/day) for 2 weeks [WI+CYA rats]; Group 3 consisted of WI+CYA rats with intraperitoneal administration of r-ANP (10ng/kg/day) for 2 weeks. Group 2 had lower glomerular filtration rates (GFR) and renal plasma flow (RPF) than Group 1, but Group 3 had significantly higher GFR and RPF than Group 2. Additionally, in order to demonstrate the change in renal viability among the three groups, the adenosine triphosphoric acid level (ATP) and adenylate energy charge ratio (EC) of renal parenchymal tissue were measured by high performance liquid chromatography (HPLC). Group 2 had lower ATP and EC than Group 1, and Group 3 had higher ATP and EC than Group 2. The results of this study suggest that r-ANP is efficacious on rat kidney damage induced by CYA and WIT.

Estimation of proliferative activity of experimental tongue carcinoma in rats. Immunohistochemical and DNA cytofluorometric analysis.

Precancerous lesions and carcinomas were produced in rat tongues by oral administration of 0.001% 4-nitroquinoline 1-oxide (4NQO) in drinking water, and the biological characteristics and tumor kinetics were studied. Bromodeoxyuridine labeling index (BrdU L.I.) was determined immunohistochemically, and the nuclear DNA content was measured by DNA cytofluorometry. The BrdU L.I. was lowest in normal epithelium (3.49 +/- 0.49%), higher in papillomas (8.24 +/- 1.76%) and highest in squamous cell carcinomas (13.36 +/- 4.40%). Normal lingual epithelial cells, papillomas and 18 of the 25 squamous cell carcinomas showed a diploid pattern, while 7 squamous cell carcinomas showed a diploid plus tetraploid pattern. The correlation between polyploidization and tumor progression was significant, but the correlation between BrdU L.I. and tumor progression was not significant. The results suggest that while polyploidization of tumors increases with tumor progression the growth rate of tumors does not necessarily do so.

[Estimation of proliferative activity of experimental tongue papillomas and carcinomas in rats--comparison with DNA cytofluorometric analysis and silver-stained nucleolar organizer regions].

Eleven tongue papillomas and 25 tongue carcinomas were produced in rats by the oral administration of 0.001% 4-nitroquinoline 1-oxide (4 NQO) in drinking water, and tumor kinetics were investigated by both DNA cytofluorometry and Ag-nucleolar organizer regions (Ag-NORs) staining. The histopathologic characteristics, the mean Ag-NOR number per cell and DNA ploidy patterns were compared. The mean Ag-NOR number was least in normal epithelium, more numerous in papillomas and highest in squamous cell carcinomas. The differences were statistically significant. All cases of normal epithelium and papilloma showed a diploid pattern. Eighteen cases of the squamous cell carcinomas (72%) showed a diploid pattern, and 7 cases (28%) exhibited a diploid plus tetraploid pattern. There was a significant difference in the mean Ag-NOR number between the two groups of squamous cell carcinomas. These results suggest that the mean Ag-NOR number may reflect the cell kinetics in the process of carcinogenesis and polyploidization of carcinomas.

[Silver-stained nucleolar organizer regions in adenoid cystic carcinoma].

The histological features of adenoid cystic carcinoma are varied. In general, the tumors are classified into 4 histological patterns: tubular, cribriform, trabecular and solid. Numerous previous reports have indicated that the tubular pattern usually represents a favorable prognosis, the solid pattern a poor prognosis and the cribriform pattern an intermediate prognosis. Therefore, the present study was undertaken to determine precisely the proliferative potential of each histological pattern of adenoid cystic carcinomas. A silver colloid technique to identify nucleolar organizer region associated protein (AgNORs) was applied to paraffin sections in a total of 16 adenoid cystic carcinomas. A morphometric analysis of highly magnified photographic images of AgNORs in light microscopic preparations was performed. Of the 16 tumors, 8 showed a mixture of different histological patterns in the same section. In comparing the AgNOR number among different histological patterns in the same section, the value was highest for the solid pattern, lowest for the cribriform pattern and intermediate for the trabecular pattern. Moreover, the mean AgNOR number also showed a stepwise increase from the cribriform pattern (2.3 +/- 0.3) through the trabecular pattern (2.9 +/- 0.2) to the solid pattern (3.3 +/- 0.6). There was a significant difference in AgNOR numbers between cribriform and trabecular and between cribriform and solid patterns. Our results indicate that the proliferative potential of histological patterns of adenoid cystic carcinoma is lowest in the cribriform, highest in the solid, and intermediate in the trabecular pattern area. The AgNOR staining technique appears to be of value in estimating the proliferative activity of adenoid cystic carcinomas.

Histological changes during progression of adenoid cystic carcinoma.

Eight cases of adenoid cystic carcinoma were reviewed to determine whether and how the histological features of the tumour vary with the progress of the disease. The tumours were classified by their histological patterns as tubular, cribriform, trabecular or solid. The relative amount of each pattern seen in routine light microscopic sections was calculated histomorphometrically and compared in the primary tumour and recurrent and/or metastatic lesions in the same case. In the early stage, the tubular pattern predominated. Later, the highest percentage shifted to the cribriform, then to the trabecular and finally, in the late stage, to the solid pattern. There was no reverse direction of histological transformation from the solid to the tubular pattern. These results may help to explain previous reports that the tubular pattern usually represents a favourable prognosis, the solid pattern a poor prognosis and the cribriform pattern an intermediate prognosis.

[Detection of human papillomavirus DNA in cases of sexually transmitted diseases (STD)].

Human papillomavirus (HPV) has been detected on the genitalia without any macroscopic abnormality and the possibility of latent infection of HPV has been suggested. Using Vira Type (Toure Co.), we have detected 7 genotypes of HPV DNA under a high stringent condition on the genitalia of patients with sexually transmitted diseases (STD), who were suspected of having had many sexual partners. In male cases of STDs other than condyloma acuminatum, the HPV-positive rate of the glans and sulcus coronarius was 4.7% (5/106). In healthy men, the HPV-positive rate was 6.1% (2/33), while in chronic prostatitis cases it was 3.4% (7/205) and in benign prostatic hypertrophy cases HPV was not detected. In female cases of STDs other than condyloma acuminatum, the HPV-positive rate of uterine cervix was 5.1% (3/58). In pregnant women, the HPV-positive rate was 4.6% (9/197). With regard to the HPV-positive rate within different age groups of STD and non STD cases, the rate tended to be higher in young people. After several weeks, follow-up studies were conducted on HPV-positive cases. HPV DNA was detected in one case of 10 males STD cases and two of 10 pregnant women, and the HPV DNA was the same type as at the first examination. However, after 3-4 months, all three of these cases had become negative for HPV DNA.

Comparative cytofluorometric DNA analysis of pleomorphic adenoma and adenoid cystic carcinoma of the salivary glands.

The nuclear DNA content in the tumor cells of 17 pleomorphic adenomas (PA) and 26 adenoid cystic carcinomas (ACC) was assayed by cytofluorometry to clarify the etiology of the differences in their biological nature. Aneuploidy was found in only two solid-pattern ACC samples; all the other samples had diploid stemlines. With respect to the polyploid cell rate and the S + G2M fraction, the differences between the four histological patterns of PA were not significant. In the ACC, the S + G2M fraction was significantly higher in solid pattern than in cribriform or trabecular pattern tumors, which may indicate that proliferative activity is higher in the solid pattern than in the other two. The polyploid cell rate in ACC was significantly higher in the solid pattern than in the cribriform pattern carcinomas. There was no significant difference in the mean polyploid cell rate between PAs and ACCs. The mean S + G2M fraction was significantly higher in all histological patterns of ACCs than in PAs. These results suggest that proliferative activity is greater in any one of the histological patterns of ACC than in PA. These findings may largely explain the biological differences between the two tumors.

[A comparative study on proliferative activity in different histological patterns of adenoid cystic carcinoma--from a viewpoint of nuclear DNA contents].

Adenoid cystic carcinoma generally consists of the following histologic features: tubular, cribriform, trabecular, and solid. To investigate how these histological patterns affect the prognosis of this carcinoma, we determined the proliferative activity of each of the histologic patterns by cytofluorometry. Twenty-six cases of adenoid cystic carcinoma, obtained by surgical resection, were studied. According to predominant histological pattern, they were divided into three groups: seven cases were of cribriform pattern, nine cases of trabecular pattern, and ten cases of solid pattern. The region with each dominant pattern was obtained from biopsy specimen, and the nuclear DNA contents of the tumor cells of the regions were assayed. In four of twenty-six cases, that of the tumor cells of the region with other patterns in the same specimens were also assayed. The results were the following: 1) The mean incidence of over 4.5C-polyploid cells of the region with predominant pattern of each tumor significantly increased in the following order: cribriform pattern and solid pattern. 2) The incidence of over 4.5C-polyploid cells, in comparison of a predominant pattern with other histologic patterns in the same tumor, were calculated. It was higher in solid pattern than in trabecular pattern, and was higher in trabecular pattern than cribriform pattern. 3) Only two of ten cases, had aneuploidy in the region with predominant solid pattern and the other cases had diploid stem line. Judging from the above results, it was concluded that proliferative activity of each pattern increased in the following order: cribriform pattern, trabecular pattern, solid pattern.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical statistics on outpatients at the Urological Clinic of Higashi Sapporo Sanjukai Hospital in 1985].

A statistical study was performed on new outpatients, the total number of which was 7,786 (male: 4,953, female: 2,833) in 1985. The male to female ratio was 1.75:1. They had urogenital diseases definitely diagnosed (6,786), tentatively diagnosed (600), normal (260), and diseases other than urogenital (140), and 36.2% of them had been referred to us by other sources. On these outpatients 206 operations had been performed circumcision, resection of condyloma and vasectomy were representative. The peak of the age distribution was in the thirties for males and in the twenties for females. For the first time in Japan, we treated renal and upper ureteral stones using extracorporeal shock wave lithotripsy (ESWL) on September 1, 1984. The results of ESWL at out hospital have been satisfactory. A statistical study was made on new outpatients according to the international disease classification. There were 152 malignant (urogenital) tumors (2.1%). The major diseases of the new outpatients were cystitis (acute or chronic: 20.6%), upper urinary tract stones (19.4%), prostatitis (13.5%), benign prostatic hypertrophy (10.7%). In males the major diseases were prostatitis, upper urinary tract stones, benign prostatic hypertrophy, balanoposthitis, and phimosis, and in females they were cystitis, upper urinary tract stone, pyelonephritis, and renoptosis. We conclude that our hospital plays a major role as a private urological hospital.

[Experience with the removal of a residual catheter in the urinary tract].

Two double J ureteral stents indwellt for 3 months and 1 year and 5 months were disrupted. These residual stents were removed by ureterorenoscopy and nephroscopy without surgery. One PCN pigtail catheter indwellt for 1 year 7 months was also disrupted. This residual catheter was removed by nephroscopy.

[Clinical statistics of the Urological Clinic of East Sapporo Sanjukai Hospital. V: Clinical statistics on patients admitted in 1984].

A clinical statistic survey was carried out on the patients, diseases and operations experienced at our urological clinic in 1984. The total number of inpatients was 1314, the male to female ratio being 2.97:1. The major diseases of the inpatients were urolithiasis (452 cases, 34.4%), and BPH (297 cases, 22.6%). Among the operations, TUR-P 34.1%, ESWL 33.0%, TUR-BT 6.9% were predominant.