Hypertrophy of the posterior longitudinal ligament in the thoracic spine.

STUDY DESIGN: This is a case report of a patient with hypertrophy of the posterior longitudinal ligament (HPLL) in the thoracic spine. This patient was followed for 10 years after surgery. OBJECTIVES: The purpose of this study was to report the long-term outcome of HPLL in the thoracic spine. SETTING: Department of orthopedic surgery, Hiroshima Red Cross and Atomic-bomb Survivors Hospital, Hiroshima, Japan. METHODS: A 58-year-old-woman with thoracic HPLL was reported. Magnetic resonance image (MRI) and computed tomography (CT) showed the expanded spinal cord compression from Th4 to Th12 due to HPLL. Anterior decompression and fusion (Th10-12) was performed. Histological findings of the surgical specimens showed thickening of the posterior longitudinal ligament with proliferation of chondroid tissue. The clinical outcome and the radiological findings (CT and MRI) were evaluated 10 years after surgery. RESULTS: The patient was asymptomatic postoperatively. However, the subsequent CT examination revealed ossification of the previously hypertrophied posterior longitudinal ligament. CONCLUSIONS: HPLL in the thoracic spine is a rare pathological condition causing myelopathy. The results of this study support the hypothesis that HPLL is one of the prodromal conditions of HPLL.

[Primary adenocarcinoma of the renal pelvis with a pyeloduodenal fistula: a case report].

A 62-year-old woman visited our hospital complaining of fever and right flank pain. On excretory pyelography the right kidney containing three renal stones was not visualized. Retrograde pyelography revealed an irregular filling defect in the right renal pelvis. Computed tomography revealed renal stones and a tumor mass in the right renal pelvis. From these findings, the pelvic tumor of the right kidney complicated by renal stones was diagnosed. Right nephrectomy was performed. Because a fistula between the renal pelvis and the second portion of the duodenum was found in the operation, partial resection of the duodenum was also performed. Pathological diagnosis was adenocarcinoma of the renal pelvis and pyeloduodenal fistula due to chronic pyelonephritis. Postoperative chemotherapy was not given. This is the first case report of adinocarcinoma of the renal pelvis coexisting with a pyeloduodenal fistula.

Effect of diabetic retinopathy on redox state of aqueous humor and serum albumin in patients with senile cataract.

PURPOSE: To investigate the oxidative status of albumin in the aqueous humor and serum of senile cataract patients with diabetes in order to clarify the pathogenesis of this condition. METHODS: High-performance liquid chromatography (HPLC) was employed to measure the reduced form of albumin (mercaptalbumin) and the oxidized form of albumin (nonmercaptalbumin) in serum and aqueous humor. The mercaptalbumin, nonmercaptalbumin-1, and nonmercaptalbumin-2 fractions in aqueous humor obtained at the start of cataract surgery and in serum obtained intraoperatively were analyzed by HPLC in 7 senile cataract patients with diabetic retinopathy (2 men and 5 women aged 70+/-9.8 years). RESULTS: The mean content (%) of mercaptalbumin, nonmercaptalbumin-1, and nonmercaptalbumin-2 in serum albumin from the diabetic patients was 60.3+/-7.8, 36.9+/-6.6, and 2.7+/-1.7%, respectively, while the corresponding values for aqueous humor albumin were 40.0+/-14.1, 52.4+/-12.6, and 7.5+/-3.6%. When the mercaptalbumin content (%) of aqueous humor albumin was compared between patients with active and inactive diabetic retinopathy, the respective values were 47.0+/-9.1% and 22.8+/-5.7%. A significant correlation mercaptalbumin content (%) of aqueous humor albumin did not show with the HbA1c level, but there was still a relationship (Y = 5.0 x - 2.7, r = 0.80, and p < 0.052). CONCLUSION: The increase of mercaptalbumin (the reduced form of albumin) in the aqueous humor of patients with diabetic retinopathy probably resulted from an increase of retinal vascular permeability.

[A case of Churg-Strauss syndrome which cheaf complain was gross hematuria].

We report a case of Churg-Strauss syndrome complaining of gross hematuria. A 74-year-old man was admitted to our hospital for further examination of gross hematuria. Abdominal CT and retrograde pyelography revealed left renal pelvic tumor, and left nephrectomy was performed. There was no tumor, but submucous hemorrhage was seen in the renal pelvis. The histopathologic diagnosis was allergic granulomatous angitis. The administration of prednisolone was done, but he suddenly died of acute heart failure after 1 month postoperatively.

Effect of mitomycin C dissolved in reversible thermo-setting gel on the outcome of filtering surgery in the rabbit.

PURPOSE: Based on our previous report that showed enhanced transfer of mitomycin C to the sclera and the conjunctiva by dissolving the agent into a reversible thermo-setting gel, we conducted a study to investigate the efficacy of mitomycin C gel in the rabbit. METHODS: We subconjunctivally injected 0.1 mL of the mitomycin C gel solution containing several different amounts of the agent. Trephination was performed in the injected region 24 hours later. Intraocular pressure measurement, photography, and ultrasound biomicroscopic examination of the filtering bleb were conducted 1, 2, and 4 weeks postoperatively. RESULTS: The gel containing 3.0 microg or more mitomycin C significantly enhanced bleb formation and reduction in the intraocular pressure. CONCLUSIONS: The reversible thermo-setting gel seems to help the filtering bleb to survive in the rabbit and deserves further investigation as a new method of mitomycin C application.

[Effect of mitomycin C dissolved in a reversible thermosetting gel on outcome of filtering surgery in the rabbit].

PURPOSE: Based on our previous report that showed enhanced transfer of mitomycin C to the sclera and the conjunctiva by dissolving the antiproliferative in a reversible thermo-setting gel, we conducted a study to investigate the efficacy of the mitomycin C-gel in the rabbit. METHODS: We subconjunctivally injected 0.1 ml of the mitomycin C-gel solution containing several amounts of the drug. Trephination was performed in the injected region 24 hours later. Intraocular pressure measurement, and photography and ultrasound biomicroscopic examination of the filtering bleb were done 1, 2, and 4 weeks postoperatively. RESULTS: The gel containing 3.0 micrograms or more mitomycin C significantly enhanced bleb formation in addition to reducing the intraocular pressure. CONCLUSION: The reversible thermo-setting gel seems to facilitate filtration following glaucoma filtering surgery in the rabbit and deserves further investigation as a new method of mitomycin C application.

[Intra-arterial chemotherapy via reservoir system for advanced bladder cancer and prostate cancer].

A clinical study was performed on the efficacy of intra-arterial chemotherapy using a reservoir system for advanced urological malignancies. The reservoir system was indwelted in the femoral subcutaneous layer by Seldinger's method. Fifteen cases of inoperable complicated advanced bladder cancer and 10 cases of postoperative local recurrent bladder cancer were administered intra-arterial chemotherapy using a reservoir system. Then, 23 cases of local relapsed prostate cancer and two cases of endpocrine-resistant prostate cancer were administered the chemotherapy. The administered anti-cancerous agents were methotraxate, cis-platinum and adriamycin, then 5-FU or carboplatin was administered as maintenance therapy. The mean number of courses of chemotherapy was six for bladder cancer and four for prostate cancer. During stabilization of the local lesion, no distant deterioration was recognized. The overall clinical efficacy was a positive response (PR) and no change (NC): for 18 and 7 cases of bladder cancer, and 11 and 14 cases of prostate cancer, respectively. The median duration of stabilization was 23 months for bladder cancer and 12 months for prostate cancer. The adverse effects were fever than those with systemic chemotherapy.

[Giant testicular tumor: a case report].

We report a case of giant testicular tumor. A 30-year-old man visited our department complaining of a painless swelling of the right scrotal contents. In chest X-ray and abdominal computerized tomography (CT) there were no abnormal findings. Serum alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase levels were normal. Right high orchiectomy was performed. The size of the removed specimen was 13.5 x 8.5 x 7.5 cm, and weight 530 g. The pathological diagnosis was immature teratoma. The patient has received no further therapy. There has been no recurrence for 7 months postoperatively.

[Intraarterial chemotherapy via reservoir system for far-advanced bladder and prostate cancer].

A clinical study was performed on the efficacy of intraarterial chemotherapy using reservoir system for far-advanced urological malignancy. The reservoir system was indwelled in the femoral subcutaneous layer using Seldinger's method. Fifteen cases with inoperable complicated advanced bladder cancer and ten cases with postoperative local recurrent bladder cancer received intraarterial chemotherapy using the reservoir system. Then, 23 cases with local relapsed prostate cancer and two cases with endocrine-resistant prostate cancer received chemotherapy. The administered anti-cancerous agents were methotrexate, cis-platinum and adriamycin, and 5-FU or carboplatin were administered as maintenance therapy. The mean courses of chemotherapy were six for bladder cancer and four for prostate cancer. During stabilization of the local lesion, no distant deterioration was recognized. Overall clinical efficacy was as follows: PR:18 cases and NC:7 cases for bladder cancer; then, PR:11 cases and 14 cases for prostate cancer. The median duration of stabilization was as follows: 23 months for bladder cancer and 12 months for prostate cancer. Complications were fewer than with systemic chemotherapy.

Effects of clomiphene citrate on serum hormone levels and endometrial thickness in an in vitro fertilization and embryo transfer program.

Hormonal alterations and pregnancy rates were compared between the clomiphene citrate (CC)-hMG combination cycle and the hMG cycle alone in an in vitro fertilization and embryo transfer program. In the CC-hMG cycle, the numbers of follicles developed, oocytes recovered and embryos transferred were higher than those in the hMG cycle (p less than 0.01, p less than 0.01 and p less than 0.05, respectively). Pregnancy rates of the CC-hMG cycle (6.7%/operation, 7.1%/embryo transfer), however, were lower than those of the hMG cycle (25%/operation, 31.6%/embryo transfer). PRL levels in the hMG cycle increased according to estradiol levels. In the CC-hMG cycle, CC might inhibit estradiol-induced hyperprolactinemia and the increase was lower even if the estradiol level was much higher than that of the hMG cycle until day 2. On day 4, the PRL level in the CC-hMG cycle further increased. The thickness of endometrium on day -2 in the hMG cycle alone was much thicker than that in the CC-hMG cycle (9.8 +/- 0.4 vs. 6.8 +/- 0.4 mm, mean +/- SEM).