magnetic dispersion and anisotropy in multiferroic BiFeO3.

We have determined the full magnetic dispersion relations of multiferroic BiFeO3. In particular, two excitation gaps originating from magnetic anisotropies have been clearly observed. The direct observation of the gaps enables us to accurately determine the Dzyaloshinskii-Moriya (DM) interaction and the single ion anisotropy. The DM interaction supports a sizable magnetoelectric coupling in this compound.

[Mitral valve repair with concomitant coronary bypass for partial rupture of an anterior papillary muscle].

We report a case of severe mitral regurgitation due to partial rupture of an anterior papillary muscle. A 63-year-old man was admitted to a hospital with heart failure. He was treated with diuretic agents effectively. Echocardiography demonstrated severe mitral regurgitation with prolapse of posterior leaflet and small mass-like structure on the prolapsed segment that was diagnosed the thickened leaflet. Coronary angiography revealed total occlusion of left anterior descending artery (LAD) filled with good collateral from right posterior descending artery and severe diffuse stenosis of circumflex artery (Cx). The patient underwent surgery on the 33rd day after admission with heart failure. At surgery, we recognized rupture of one of the heads of anterior papillary muscle that was entangled in chordae of the prolapsed segment. Mitral valve repair and coronary revascularization to LAD and Cx was successfully performed. His postoperative course was uneventful, and he was discharged on the 28th postoperative day.

Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients.

STUDY DESIGN: Analysis of answers to a new questionnaire. OBJECTIVE: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. SETTING: Nationwide questionnaire survey to physicians in Japan. METHODS: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). RESULTS: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping. CONCLUSIONS: This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.

Perforated appendicitis causing thigh emphysema: a case report.

We report a case of thigh emphysema resulting from perforated appendicitis. The patient was an 83-year-old man who had no apparent abdominal signs and was initially misdiagnosed as having psoas abscess. Magnetic resonance imaging of the pelvis revealed appendicitis, and a barium enema showed a leakage of enhanced contrast material from the appendix region down into the thigh. A retroperitoneal perforation of the retrocaecal appendix without peritonitis was diagnosed. The patient underwent an appendectomy and curettage of the retroperitoneal and psoas muscle spaces, as well as the thigh. He recovered gradually, though the abscess had extended into the hip joint and resulted in osteomyelitis, requiring an additional procedure of resection arthroplasty. The patient fully recovered with no signs of infection one year postoperatively.

Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids.

BACKGROUND: Recent studies have shown that adipose tissue is an endocrine organ that releases various cytokines. OBJECTIVE: To investigate the production of growth factors and proinflammatory cytokines in infrapatellar fat pad specimens. METHODS: Infrapatellar fat pad tissues were obtained from patients during knee surgery. Protein levels of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)alpha, and interleukin (IL)6 in homogenised tissues were measured by an enzyme immunoassay. Gene expressions for those cytokines were examined by reverse transcription-polymerase chain reaction (RT-PCR). Localisation of bFGF and VEGF was evaluated by immunohistochemistry and in situ hybridisation. RESULTS: Infrapatellar fat pads were found to contain various protein levels of bFGF, VEGF, TNF alpha, and IL6. Further, gene expressions for these cytokines were detected by RT-PCR. Immunohistochemistry and in situ hybridisation showed that the expressions of both bFGF and VEGF were localised in immature adipocytes, interstitial undifferentiated mesenchymal cells, and vascular endothelial cells. CONCLUSION: The production of bFGF, VEGF, TNF alpha, and IL6 in the infrapatellar fat pad was demonstrated. Although synovial cells and articular chondrocytes are thought to be primary sources of cytokines found in knee synovial fluids, the results suggest that they may also originate from this fat pad.

[Licorice-induced pseudoaldosteronism in a patient with a non-functioning adrenal tumor].

A 72-year-old man was diagnosed with hypertension, hypokalemia, and left adrenal tumor at another hospital, and was referred to our hospital on suspicion of primary aldosteronism. Investigations revealed low plasma aldosterone concentration, and the left adrenal tumor proved to be nonfunctioning, not hyperfunctioning. "Licorice" had been prescribed for the treatment of recurrent cramps in his calf. After stopping the licorice, his condition changed to normokalemia strongly suggesting that his pseudoaldosteronism had been caused by the drug. We reviewed 140 reports on licorice-induced pseudoaldosteronism in Japan, and found a second patient who might have suffered a similar coincidental nonfunctioning adrenal tumor.

A case of traumatic renal graft rupture with salvage of renal function.

An 18-yr-old man received a kidney graft from a 60-yr-old female cadaver donor on February 8, 1996. Postoperative course was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On April 30, 1999, he collided with a truck while riding a motor cycle. Macroscopic hematuria was observed and CT showed an extensive retroperitoneal hematoma. Because his anemia and hypotension were becoming worse after transfusion of 9 units of blood, he was operated on as an emergency case. A large rupture reaching the pelvis and calyces was observed in the upper pole of the grafted kidney. There were also numerous shallow lacerations, but the major arteries and veins were not injured. The rupture was closed by suturing the renal parenchyma with the peritoneum, and the other shallow lacerations were closed by suturing the renal capsule. The kidney could be salvaged without requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during follow-up. A review of the literature showed that 6 cases of traumatic renal graft rupture with salvage of the kidney have been reported. Our present case was the seventh, and was the most severe graft rupture reported so far.

Comparison of 3 surgical approaches to laparoscopic adrenalectomy: a nonrandomized, background matched analysis.

PURPOSE: To clarify the characteristics of surgical approaches to laparoscopic adrenalectomy we performed background matched analysis of clinical outcomes of the 3 approaches. MATERIALS AND METHODS: From February 1992 to July 2000 we performed 118 laparoscopic adrenalectomies in 115 patients with adrenal tumors. For these operations we used the anterior transperitoneal approach in 46 patients, the lateral transperitoneal approach in 32 and the lateral retroperitoneal approach in 40. RESULTS: To exclude the learning curve effect we eliminated our initial 20 patients treated with the anterior transperitoneal approach. To allow background matching of the 3 groups we also excluded 14 patients with tumors more than 5 cm., 6 who underwent conversion to open surgery and 1 patient who required 5 days of bed rest for retroperitoneal hematoma caused by bleeding from a trocar port. The final analysis included 16, 25 and 36 cases managed via the anterior transperitoneal, lateral transperitoneal and lateral retroperitoneal approach, respectively. Average operative time was significantly shorter for the lateral transperitoneal approach. Postoperative recovery was not significantly different in the lateral transperitoneal and lateral retroperitoneal groups. Postoperative complications included mild paralytic ileus in 2 patients and shoulder tip pain, probably peritoneal irritation due to carbon dioxide insufflation and bowel preparation, in 4 in the transperitoneal groups. Our results imply that the easiest procedure is the lateral transperitoneal approach but the lateral retroperitoneal approach is slightly less invasive. CONCLUSIONS: Although it is important to remember that this study was not a prospective randomized trial and, thus, had from certain biases, we believe that if a tumor is more than 5 cm. and/or the surgeon is not yet skilled in laparoscopic adrenalectomy, the lateral transperitoneal approach is the most suitable method. If the surgeon has performed at least 20 operations, the adrenal tumor is unilateral and the lesion is less than 5 cm., the lateral retroperitoneal approach seems to be more suitable because of its minimally invasive nature. The lateral retroperitoneal approach is also preferred in patients with a history of upper abdominal surgery. With improvements in technique and new instruments the time required for the lateral retroperitoneal approach has been significantly decreased.

Self-assembly of a porphyrin array via the molecular recognition approach: synthesis and properties of a cyclic zinc(II) porphyrin trimer based on coordination and hydrogen bonding.

Self-assembly of [5-(pyrazol-4-yl)-10,20-bis(p-tolyl)-15- (2-ethoxycarbonylphenyl)porphyrinato]-zinc(II) (1), designed to have both a coordination site and a hydrogen bonding site, leads to a stable cyclic trimer array where coordination of the pyrazole nitrogen to the zinc(II) ion as well as hydrogen bonding between carbonyl oxygen and pyrazole NH holds each zinc(II) porphyrin. The recognition event for pyrazole has been confirmed preliminarily in the model studies using [5-(2-ethoxycarbonylphenyl)tris(p-tolyl)porphyrinato]-zinc(II) (3). The zinc(II) porphyrin 3 has large affinity for pyrazole due to the hydrogen bond between pyrazole and the 2-ethoxycarbonyl group in addition to the coordination bonding accompanied by the conformational change of the ethoxycarbonyl group in the coordination process. The (1)H NMR, IR, and UV-vis spectra of 1 and its ESI-MS and VPO measurements have revealed the cyclic trimer structure with an overall association constant of 6.0 x 10(13) M(-2) at 22 degrees C. The contribution of the hydrogen bond to the total free energy change in trimer formation is estimated to be 7.5 kcal/mol based on a reference trimer system without a hydrogen bonding site. The trimer geometry causes characteristic exitonic interaction between porphyrin units to yield a broad Soret band which is deconvoluted into four components by UV-vis and MCD spectral analyses. Electrochemical measurements have shown that only the first ring-oxidation process proceeds stepwise in the trimer.

Simultaneous bilateral laparoscopic adrenalectomy in ACTH-independent macronodular adrenal hyperplasia.

Laparoscopic surgery for urological conditions has now become popular worldwide. The case is reported of a 56-year-old woman who underwent simultaneous bilateral laparoscopic adrenalectomy for adrenocorticotropic hormone-independent macronodular adrenocortical hyperplasia (AIMAH), followed by autotransplantation of resected adrenal gland fragments. Simultaneous laparoscopic adrenalectomies seem feasible for a patient with AIMAH because of its minimally invasive nature. However, autotransplantation of adrenal fragments failed in this patient with AIMAH.

[A case of pheochromocytoma with von Recklinghausen's and review of 67 Japanese cases].

A 19-year-old woman with von Recklinghausen's disease was referred to our hospital because of right adrenal pheochromocytoma. The tumor was detected incidentally with the abdominal ultrasonography when she complained epigastralgia to the home doctor who treated her hypertension. Plasma and urinary catecholamines level were elevated. The tumor was removed by laparoscopy assisted adrenalectomy without pneumoperitoneum. The resected specimen was 35 x 60 x 75 mm in size and weighed 70 g. Pathological diagnosis was adrenomedullary pheochromocytoma. Postoperative course was uneventful. She has been well with no signs of recurrence after 7.5 years. We reviewed 67 Japanese patients previously reported as von Recklinghusen's disease with pheochromocytoma. Of the 60 patients whose details were described, 16.7% had metastases and pathological malignancy from pheochromocytoma.

Cavernous hemangioma of the liver with giant cyst formation: degeneration by apoptosis?

Cavernous hemangioma of the liver with cyst formation is a very rare condition. A case of cavernous hemangioma of the liver with unilocular giant cyst formation undergoing surgical removal is reported. Notably, the patient also had Budd-Chiari syndrome with an obstructing lesion in the inferior vena cava. The cystic degeneration of the hemangioma implied a relationship with apoptosis. This is the first reported case of Budd-Chiari syndrome caused by advanced cystic degeneration of hepatic cavernous hemangioma.

Voiding dysfunction in a patient with adolescent adrenoleukodystrophy.

The details are reported of bladder dysfunction in a Japanese boy with adrenoleukodystrophy. He developed gait disturbance at the age of 15 years. Spastic paraparesis progressed from the legs to the hands and brain magnetic resonance imaging showed characteristic degenerative change. Detrusor hyperreflexia was found by a urodynamic study and detrusor-sphincter dyssynergia was also suspected.

Prevalence of large-joint osteoarthritis in Asian and Caucasian skeletal populations.

OBJECTIVE: To determine ethnic variations of large-joint osteoarthritis (OA) in past populations. METHODS: One thousand two hundred and nine adult skeletons, excavated from archaeological sites in Japan, China and France were assessed for OA as defined by the presence of eburnation. RESULTS: Within Asian skeletal populations, elbow OA and patellofemoral joint OA were more common in hunter-gatherers than in agriculturalists. Compared with Caucasians, the Asian skeletal population had a higher prevalence of tibiofemoral joint OA. CONCLUSION: The relative frequencies of OA within and between ethnic groups at certain joint sites have changed over time from the past to the present.

Vesicoureteral reflux in the early stage of spinal cord injury: a retrospective study.

STUDY DESIGN: A retrospective study. OBJECTIVES: To investigate the risk factors of vesicoureteral reflux in the early stage of spinal cord injury. SETTING: Japan. METHODS: Urological evaluation, including cystography and urodynamic study was performed in patients in the early stage of spinal cord injury. The patients were divided into two groups. Group 1 included 13 patients with vesicoureteral reflux. Group 2 included 97 patients without vesicoureteral reflux. We compared Group 1 and Group 2 regarding bladder deformation, the level of spinal cord injury, bladder behaviour, bladder compliance, high urethral closure pressure and method of urine evacuation. RESULTS: The patients injured between Th10 and L2 showed a significantly higher incidence of vesicoureteral reflux than those injured in other areas (P<0.01). Furthermore, bladder compliance among patients with vesicoureteral reflux tended to be low. Other factors showed no differences between patients with and without vesicoureteral reflux. CONCLUSION: Injuries between Th10 and L2 involve the sympathetic nervous system. Patients with such injuries often exhibited vesicoureteral reflux in the early stage of spinal cord injury.

Clinical usefulness of chemotherapy based on an in vitro chemosensitivity test in urothelial cancer patients.

BACKGROUND: We evaluated the clinical usefulness of individualized chemotherapy based on an in vitro chemosensitivity test, i.e., the histoculture drug response assay (HDRA), for urothelial cancer. MATERIALS AND METHODS: 62 clinically obtained cancer specimens were studied. Each specimen was tested for sensitivity to nine anticancer drugs. The antitumor effect was calculated as the inhibition rate to their control values. The HDRA effective cytotoxic drugs were selected for clinical treatment. RESULTS: HDRA was possible in 58 out of 62 specimens (93.5%). Their chemosensitivity showed a wide variety even among the same histological category. No correlation was seen between histological grade and chemosensitivity. The effect of chemotherapy on the measurable lesions was studied in 12 patients and good clinical responses were obtained in 7 of them (58.3%). All 7 responders were the patients who received drugs predicted to be effective by HDRA. In 8 out of the 12 patients (66.7%), including 7 true-positive and 1 true-negative, HDRA correctly predlicted the clinical effect of chemotherapy. CONCLUSION: The HDRA might be feasible for predicting the efficacy and, therefore, selecting the proper anticancer drug for individual patients.

[Penile metastasis from renal cell carcinoma: a case report].

Penile metastasis is rare. It occurs in the advanced stage of genitourinary cancer, with many other metastases in various organs. All 7 patients with penile metastasis of renal cell cancer, reported in the Japanese literature, died within a year. Our case was not the exception. A 69-year-old male presented with right flank pain and penile induration. Right renal cancer with liver invasion and multiple pulmonary metastases were found. Microscopic examination revealed a sarcomatous pattern. He died 4 months later.

Intracystic hemorrhage of pancreatic serous cystadenoma after renal transplantation: report of a case.

Immunosuppressive therapy after transplantation increases the risk of developing neoplasms, and neoplasms of the digestive organs are very common in Asia. We experienced a patient with an intracystic hemorrhage of pancreatic serous cystadenoma during the follow-up after renal transplantation. Pancreatic cystadenomas are not frequent. Only two cases, presenting with acute abdomen, have so far been reported in the literature. The intracystic hemorrhage in our case may have been related to a rapid tumor growth due to weakened antitumor immunity and azathioprine-induced pancreatitis.