[ANEURYSMAL TYPE RENAL ARTERIOVENOUS FISTULA WITH GIANT VENOUS ANEURYSM, MIMICKING RENAL CELL CARCINOMA: A CASE REPORT].

A 39-year-old man was referred to our clinic for a 7 cm tumor in the right kidney, found by simple CT scan. It was suspected as renal cell carcinoma accompanying tumor emboli in the inferior vena cava by enhanced CT scan. For further evaluation of the tumor emboli, color Doppler ultrasound and enhanced MRI was performed. They showed a large cystic lesion with high velocity turbulent flow and flow voids in T2-weighted imaging, it seemed as giant venous aneurysm of the right renal vein. Subsequently, angiography revealed aneurysmal type renal arteriovenous fistula (AVF), transarterial embolization (TAE) of the arterial feeder with coils was performed on the same day. After 6 months from embolization, there was no recurrences or reinterventions. Color Doppler ultrasound and MRI are beneficial in distinguishing vascular disease from neoplastic disease which may sometimes mimick in other diagnostic imaging studies. In addition TAE seems to be an effective treatment for the AVF.

Soft coagulation in partial nephrectomy without renorrhaphy: feasibility of a new technique and early outcomes.

OBJECTIVES: To study the feasibility of a new partial nephrectomy technique using soft coagulation without renorrhaphy. METHODS: Open partial nephrectomy using soft coagulation without renorrhaphy was carried out on 39 consecutive patients with renal tumors. The renal artery was clamped in the initial 23 cases (59%), whereas 16 surgeries (41%) were carried out without clamping. The resected surface of the kidney was coagulated solely by soft coagulation without renorrhaphy. Suturing was used only when the urinary collecting system was opened. The surgical results and perioperative complications were retrospectively evaluated. RESULTS: The mean age of patients was 63.1 years. The mean tumor size was 28.2 mm (range 10-56 mm). The mean RENAL nephrometry score was 8.03 (range 4-10). The mean cold ischemic time (in clamped cases) was 25 min. The mean operative time was 193 min (range 113-310 min), and the mean estimated total blood loss was 172 mL (range 20-530 mL) in all cases. All operations were uneventful, and none required blood transfusion or conversion to nephrectomy. Postoperative complications, such as hemorrhage, urinary fistula formation and requirement of hemodialysis, were not observed. All patients had negative surgical margins, and were free of disease recurrence during the follow-up period (3-49 months). Overall, a remarkable decrease in renal function was not evident at the end of the follow-up period. CONCLUSIONS: This new technique using soft coagulation appears to be safe and feasible for partial nephrectomy.

[Group a streptococcal necrotizing fasciitis of the genital area (Fournier's gangrene): a case report].

A necrotizing fasciitis especially caused by group A streptococcal infection is a life-threatening disease. This infection cause death due to septic shock and multiple organ failure in a short time without the immediate and adequate treatment. Currently a rapid test kit for streptococcal pharyngitis (strep A) is useful for prediction of group A streptococcal infection. We here demonstrate a 61 years old man's case of life-saved necrotizing fasciitis in genital area (Fournier's gangrene) by group A streptococcus infection, and usefulness of this kit for rapid diagnosis, aggressive debridement, and selection of adequate antibiotics.

Automatic measurement of sake fermentation kinetics using a multi-channel gas monitor system.

In small-scale sake brewing tests, progression of ethanol fermentation is examined by monitoring carbon dioxide emission using the Fermograph, an automated multi-channel gas monitor instrument. The Fermograph system enables automatic measurements of fermentation profiles with high accuracy, reproducibility, and resolution, and facilitates comprehensive and quantitative sake fermentation kinetic analyses.

Two von Recklinghausen's disease cases with pheochromocytomas and gastrointestinal stromal tumors (GIST) in combination.

We here document two cases of von Recklinghausen's disease with both pheochromocytomas and gastrointestinal stromal tumors (GIST). It is very rare that these three disorders are found to occur simultaneously, although the fact that preoperative detection of GIST is difficult except with large tumors may be important in this respect. In the present cases, GIST were not evident on preoperative computed tomography and magnetic resonance imaging, and were identified unexpectedly during surgery. Our findings indicate that investigation of the intraperitoneal space should be performed during adrenalectomy for pheochromocytomas with von Recklinghausen's disease.

[Survey of factors underlying treatment choice for patients with localized prostate cancer (radical prostatectomy vs extrabeam radiotherapy)].

PURPOSE: Little is known regarding factors for decision-making on treatment by localized prostate cancer patients. We therefore conducted a survey series of cases for influence on treatment decision making, and also satisfaction after therapy. MATERIALS AND METHODS: A total of 51 patients with localized prostate cancer treated with radical prostatectomy (RP) or external beam radiation therapy (EBRT) were mailed original questionnaires about their treatment decision-making factors and satisfaction and the results compared between the two groups. RESULT: Some 48 (94.1%) patients responded to the questionnaire, 38 (79.2%) and 10 (20.8%) after RP and EBRT, respectively. The major factor determining the decision as to treatment approach was the physician in both groups (more than 90%). Excluding physicians, family or others were more important in the RP group than the EBRT group (p = 0.023). RP group patients desired removal of their prostate for cancer control, while, EBRT group patients favored the less invasive approach in consideration of side effects. Over 80% patients indicated they would definitely or probably choose the same treatment again, although some of the RP group would switch to watchful-waiting because of sexual dysfunction, urinary incontinence and the invasive nature of the procedure. CONCLUSION: Physicians are in a most important position to help patients understand prostate cancer and treatment, outcomes, and need to help them make their best choice, with appropriate follow up including mental care.

Transgenic rats carrying human c-Ha-ras proto-oncogene are highly susceptible to N-nitrosomethylbenzylamine induction of esophageal tumorigenesis.

A transgenic rat line carrying three copies of the human c-Ha-ras proto-oncogene, including its own promoter region, has been established in our laboratory (Hras128 rats), and shown to be highly susceptible to induction of mammary and urinary bladder tumors. Mutation analysis of induced lesions indicated the majority to contain some but not all cells with transgene mutation. In the present study, the susceptibility of Hras128 rats to N-nitrosomethylbenzylamine (NMBA) induction of esophageal tumors was examined with a similar mutation analysis of the transgenes. Male 6-week-old Hras128 and wild littermate rats were treated with NMBA, 0.5 mg / kg subcutaneously, 3 times a week for 5 weeks and then maintained for 5 weeks without any further treatment. Multiple esophageal tumors, squamous cell papillomas and carcinomas, rapidly developed within this 10-week experimental period in Hras128 rats (11.05 +/- 7.83 / rat). In contrast, wild-type littermates had only small numbers of mostly benign tumors (1.67 +/- 2.06 / rat). The Hras128 rats had no other tumors or abnormalities. In their esophageal lesions, codon 12 GGC to GAC mutations of the transgene were frequently detected by restriction fragment length polymorphisms (RFLP) and subsequent direct sequencing analysis (19 / 25, 76%). In the endogenous rat c-Ha-ras gene they were less frequent (2 / 25, 8%), than in wild-type rats (8 / 14, 57.1%). The densities of mutated bands in the RFLP analysis indicated that mutated cells were major populations in tumors, in contrast to the case with mammary and urinary bladder lesions. Furthermore, activated ras protein, detected by binding to raf protein, was clearly increased in tumors as compared to surrounding epithelium or the normal esophagus of untreated rats. The results show that Hras128 rats are highly susceptible to NMBA esophageal carcinogenesis, as well as induction of mammary and urinary bladder tumors, but that tissue-specific characteristics exist for the roles of transgene ras mutations.

[Saphenous vein grafting for Peyronie's disease: a case report].

We present a case of Peyronie's disease in a 50-year-old male with a progressive, painful induration (3 x 2 x 0.5 cm) in the dorsal region of the penis. In order to correct the high degree of penile curvature, we made a venous patch graft from the saphenous vein under general anesthesia and straightened the penis. Six months after the operation, a recurrent induration was observed in the proximal region of the penis, and the penis became slightly shortened.

Mammary carcinomas induced in human c-Ha-ras proto-oncogene transgenic rats are estrogen-independent, but responsive to d-limonene treatment.

We have previously shown that transgenic rats carrying three copies of the human c-Ha-ras proto-oncogene (Hras128) are highly susceptible to N-methyl-N-nitrosourea (MNU) mammary carcinogenesis. All transgenic rats treated with 50 mg / kg MNU, i.v. at 50 days of age, were found to rapidly develop multiple, large mammary carcinomas within as short a period as 8 weeks. In the present study, the effects of ovariectomy and treatment with d-limonene, known to inhibit mammary carcinogenesis in non-transgenic female rats, were investigated in Hras128 animals treated with MNU to clarify the role of the human c-Ha-ras proto-oncogene and to characterize the induced mammary carcinomas. Although ovariectomy completely inhibited development of mammary carcinomas in their wild-type counterparts, it did not affect either the incidence or the multiplicity of the mammary carcinomas in the Hras128 rats. On the other hand, treatment with d-limonene, an inhibitor of ras protein isoprenylation, inhibited the breast tumor development. These results indicate that aberrant c-Ha-ras gene expression is involved in ovarian hormone-independent growth and c-Ha-ras protein isoprenylation plays an important role in mammary carcinogenesis.