No associations between five polymorphisms in COMT gene and migraine.

OBJECTIVES: The pathophysiology of migraine headaches is not clearly understood yet. The dopaminergic system has been hypothesized to be involved in migraine pathogenesis. The aim of this study was to investigate catechol-O-methyltransferase (COMT) polymorphisms and chronic headaches. We analyzed five single nucleotide polymorphisms (SNPs) in COMT. MATERIALS & METHODS: The study population consisted of 71 patients with migraine with aura, 152 patients with migraine without aura, 86 patients with tension-type headache, and 191 healthy controls. The selected polymorphic markers included one causing His62His (rs4633) and two non-synonymous SNPs, Ala72Ser and Val158Met (rs6267, rs4680 respectively). Two other non-polymorphic SNPs (rs6270, rs740602) were examined. RESULTS: We found no significant differences in any genotypes, allele frequencies, or haplotypes among the patient groups and controls. CONCLUSIONS: Our results indicate that the five polymorphisms in COMT have no association with migraineurs in Western Japan. The possibility that segments elsewhere in the gene may contain a mutation responsible for modifying the expression of COMT or the activity of the enzyme is important. We cannot conclusively exclude the entire COMT gene from being involved in migraine pathogenesis.

Tissue polypeptide antigen expression in human prostate tumors.

Thirty-seven specimens of benign and malignant prostatic tumors were studied for the localization of tissue polypeptide antigen (TPA) by an avidin-biotin-peroxidase complex technique. In addition, 23 metastases of prostatic carcinoma in other organs and 12 nonepithelial tumors of prostate also were studied. All benign and malignant tumors of epithelial origin, including their metastasis, stained positively. Nonepithelial tumors were uniformly negative. In the metastatic lesions, small foci of tumor cells and even single tumor cells could be identified by TPA staining. Immunohistochemical localization of TPA appeared to be a useful tool for assessing the micrometastases of prostatic carcinoma in other organs, especially lymph nodes, or elucidating the epithelial origin of an otherwise undifferentiated prostatic cancer.

Direct immunofluorescence for ABH blood group isoantigens: use of FITC-conjugated lectins.

A direct immunofluorescence method was used to detect A, B, or H blood group isoantigens in deparaffinized tissue sections of 30 bladder tumors of various grades and stages. The results were compared with those of the specific red cell adherence test performed on the replicate sections. The two methods showed identical results for isoantigens A, B, and H. Direct immunofluoresence method appeared to be less time-consuming, more simple to perform, and reproducible with less subjectivity in the interpretation of the results.

[Manifestation of primary biliary cirrhosis and Basedow's disease caused by exposure to carbon monoxide in a patient with HTLV-1 associated myelopathy].

A 55-year-old woman with HTLV-1 associated myelopathy (HAM) was discovered in a rentan kotatsu (Japanese foot warmer with a frame and a coverlet by burning briquet) with conscious disorder and admitted to an emergency hospital. Her conscious disturbance waned the 3rd day after admission with gradual improvement of communication and food intake. However, on the 18th day after admission, her orientation was poor again and she was unable to take food for herself and keep sitting. She was diagnosed as suffering from an interval form of acute carbon monoxide (CMO) poisoning and transferred to our hospital for the purpose of hyperbaric oxygen therapy on the 20th day after exposure to CMO. In the course of treatment she recovered but showed jaundice, pruritus, liver dysfunction and elevation of antimitochondrial antibody. She received liver biopsy and was found to have primary biliary cirrhosis (PBC). On the 150th day, she manifested perspiration and hypertension. The clinical and immunological feature revealed her Basedow's disease. The relationship between HAM and PBC due to the autoimmune process has been predicted by investigators. The implication of autoimmune disease and HLA haplotype is a main focus of attention. Our case supports their hypothesis, and suggested that the complication occurred with immunological and genetic correlation. Anti-HTLV-1 antibody was positive at a titer of 1:8192 before exposure to CMO. On transferring to us, it was negative and revealed excessive positive at a titer of 1:20,480 on the 80th day. Immunoglobulin analysis was normal on admission and increased during hospitalization. It was reported that prenatal exposure to relatively mild concentrations of CMO in rats reduces splenic macrophage phagocytosis and killing ability as well as macrophage respiratory burst. These data suggested that PBC and Basedow's disease were manifested by exposure to carbon monoxide.

[Uretero-caliceal anastomosis]. / Anastomose urétéro-calicielle.

We report our experience of ureterocalycostomy in two patients with good results. Some technical points and the indications of this plastic surgery are discussed. If ureteropelvic anastomosis is impossible, this method of surgery must be tried before performing urinary diversion, such as nephrostomy.

[Liposarcoma arising from the renal capsule].

Liposarcoma is one of the most common soft tissue sarcomas, but liposarcoma arising from the renal capsule is rare. We report a case of liposarcoma arising from the renal capsule. Preoperative diagnosis was achieved by computerized tomography and and selective renal angiography. The tumor resected with he left kidney which weighed 4,370 g. Postoperative adjuvant chemotherapy with cyclophosphamide, bleomycin, actinomycin D, adriamycin and vinblastine was carried out. Although the patient's general conditions was fine, local recurrence occurred after 24 months postoperatively. Five cases of liposarcoma arising from the renal capsule including our case have been reported in Japan.

[Asymptomatic renal cell carcinoma incidentally detected by abdominal CT].

We reported two cases of renal cell carcinoma incidentally detected by abdominal CT during the evaluation of another clinical problem. They had no relevant symptoms of renal cell carcinoma. Case 1: The tumor was 32 X 33 X 34 mm. Histopathological diagnosis was clear cell subtype, tubular type greater than alveolar type, grade 1, INF alpha, pT2b, pV0, pNX, pM0. Case 2: The tumor was 20 X 20 X 16 mm. Histopathological diagnosis was clear cell subtype, alveolar type, grade 1, INF alpha, pT1, pV0, pNX, pM0.

[Management of hemorrhage secondary to renal angiomyolipoma].

A case of bilateral angiomyolipoma which was complicated with retroperitoneal massive hemorrhage and in which right-nephrectomy was performed is reported. Eight years ago, this patient had tuberous sclerosis and underwent open renal biopsy with which the diagnosis was confirmed. This patient was admitted for shock caused by the retroperitoneal massive hemorrhage from tumor. For about 30 days, the patient was treated conservatively, such as blood transfusion and hyperalimentation, but retroperitoneal massive hemorrhage reoccurred and the patient underwent right-nephrectomy. The treatment for bilateral angiomyolipoma complicated with retroperitoneal massive hemorrhage is discussed.

[One-stage operation of ureteropelvic junction and ureterovesical junction stricture].

One-stage surgical management for ureteropelvic (UP) and ureterovesical (UV) strictures is reported. A 3-year-old boy with UP and UV strictures on left side, underwent nephrostomy at 4 months old. The plastic operations which were Anderson-Hynes method for UP stricture and submucosal tunnel method with tailoring of dilated ureter for UV stricture were performed at the same time. The post-operative intravesical pyelogram and renal scintigraphy showed the improvement of hydronephrosis. Many authors have described two-stage operations for such cases. Our findings revealed that one-stage operation, carefully preserving the blood supply to the ureter, would be an alternative surgical management for UP and UV strictures.

[Mesh-graft urethroplasty: a case report].

We used a meshed free-foreskin transplant in a two-stage procedure for reconstruction of the extended stricture of urethra after direct vision urethrotomy. The results were excellent. Mesh-graft urethroplasty is a useful method for patients with extended strictures of the urethra or recurrent strictures after several operations.

[Malignant lymphoma of the testis].

Two cases of malignant lymphoma arising from the testis are presented. High inguinal orchiectomy was performed on a 72-year-old and a 79-year-old man. Histological findings were malignant lymphoma of the testis. One was large cell type and the other was mixed cell type in diffuse lymphoma according to the LSG classification. We reviewed 22 malignant lymphomas of the testis reported in Japan along with LSG classification.

[Emphysematous pyelonephritis: report of a case].

A case of emphysematous pyelonephritis is presented. A 54-year-old woman with diabetes mellitus was admitted because of bilateral ureteral stones. Five days after bilateral ureterolithotomy, she developed left flank pain, chills and fever. Plain x-rays of the abdomen (KUB) showed an enlarged left kidney with a giant gas shadow on the left renal area and no evidence of stone shadow. Drip infusion pyelogram revealed a decrease in the left renal function and the presence of the gas in the pyelocalyceal system. Contrast-enhanced computerized tomograms confirmed the presence of the gas in the parenchyma and pyelocalyceal system. The patient was treated conservatively with intensive antibiotic therapy, intravenous fluids and control of diabetes mellitus. After 3 weeks of therapy, the gas shadow disappeared, and a good recovery of renal architecture and function was achieved.

[Cutaneous metastases from transitional cell carcinoma of the bladder].

Two cases of transitional cell carcinoma of the bladder with cutaneous metastases are reported. In one patient, multiple nodular metastatic lesions appeared simultaneously with urethral recurrence after total cystectomy. In another patient, diffuse inflammatory metastatic lesion was generated after radiotherapy for pelvic lymph nodes. The pathways of metastatic dissemination from the transitional cell carcinoma of the bladder are discussed.

[Inverted papilloma of the ureter].

Two cases of ureteral inverted papilloma are reported. Case 1: A 48-year-old male had asymptomatic gross hematuria and filling defect of left middle ureter on intravenous pyelography. Segmental resection of ureter was performed. The specimen was a 1 cm polypoid lesion with histologic features resembling "multifocal bud-like proliferation", which was reported as the initial stage of the inverted urothelial tumor by Kunze et al. Case 2: A 64-year-old female with asymptomatic gross hematuria and complete obstruction of left middle ureter on ante- and retrograde pyelograms. Total nephroureterectomy was performed. A 4 cm lobulated and pedunculated lesion with histologic features of typical inverted urothelial papilloma was resected. Twenty-one cases of ureteral inverted papilloma in the literature, including our cases, are analyzed.

[A case of fibrosarcoma of the kidney extending into the inferior vena cava].

A case of fibrosarcoma of the kidney extending into the inferior vena cava with intraoperative development of massive neoplastic pulmonary emboli is reported. A 38-year-old man was admitted to our hospital because of right renal tumor with gross hematuria, right flank pain and abdominal tumor. Inferior venacavograms and computerized tomography demonstrated almost total occlusion of the abdominal part of the vena cava by tumor thrombi. No signs of inferior vena caval involvement were present. Intraoperative pulmonary neoplastic emboli suddenly occurred after right nephrectomy was performed. Immediately, pulmonary thrombectomy was performed with extra-corporeal circulation. Postoperatively, pulse, blood pressure and ventilation were stable, but the patient remained unconscious and neurologic signs gradually deteriorated. Computerized tomography of the brain showed diffuse brain edema and infarctions. The patient died of cardiopulmonary insufficiency with multiple pulmonary metastasis 8 months postoperatively. We emphasize the risk of fragmentation and migration of the tumor thrombi during surgical treatment of neoplasm of the kidney invading the inferior vena cava.

[Endoscopic findings of nipple fixation in Kock pouch].

Fixing the nipple to the pouch wall is indispensable to reduce the incidence of late complications of the Kock pouch. We performed endoscopy of the Kock pouch in 28 patients to evaluate the nipple valve fixation. We carried out submucosal fixation of nipple in 17 patients, fixation using staples in 2 patients and full layer fixation in last 9 patients. On endoscopy, both efferent and afferent nipples were poorly fixed or completely detached in 8 of the 17 patients who underwent submucosal fixation. On the other hand, there were no patients in whom the nipple was poorly fixed or completely detached among the other 11 patients. We experienced nipple malfunction in only one of the last 9 patients. Based on endoscopic findings and clinical results, we concluded that full layer fixation was reliable and useful to reduce the incidence of nipple valve complications.

[Metastatic tumor of the spermatic cord from gastric cancer].

A 70-year-old male who had undergone gastrectomy due to gastric cancer 6 years previously visited our department complaining of perineal and bilateral scrotal mass. Biopsy specimen of the perineal mass showed well-differentiated adenocarcinoma. The spermatic cords were resected en bloc with the entire scrotal content, penis and perineal skin. Histological examination of the spermatic cord, epididymis and perineal subcutaneous tissue revealed well differentiated adenocarcinoma similar to that of the lesion resected from the stomach 6 years earlier. The patient was followed for 2 years with no evidence of recurrence. Metastatic tumors of the spermatic cord and epididymis resulting from gastric cancer are rare and 31 cases previously reported in the Japanese literature are reviewed.

[Renal cell carcinoma in the solitary kidney].

We have treated surgically 5 patients with renal cell carcinoma in the solitary kidney. The cause of renal absence was nephrectomy for renal stones, in 2 patients and renal tuberculosis, renal cyst and renal hypoplasia in 1 patient each. Four of the 5 patients died. One of the 4 patients died 5 days after surgery due to gastrointestinal bleeding, 1 due to metastasis, 1 due to gastric cancer and one due to hemodialysis complications. Surgical management of renal cell carcinoma of solitary kidney is discussed.

[Renal artery thrombosis following surgical treatment of chyluria].

A case of segmental renal arterial thrombosis occurring after bilateral surgical stripping and interruption of renal pedicle lymphatics for chyluria is presented. This case showed elevation of serum creatinine (6.6 mg/dl) and lactate dehydrogenase (1131 IU/L) on the 4th day after operation, and on the 14th day, renal scintigraphy with 99 m-Tc diethylenetriamine penta acid acetic showed bilateral marked decrease of glomerular filtration rate. Aortography and selective left renal angiography demonstrated left segmental renal thrombosis, but right renal arteries were intact on the 20th day after operation. Systemic anticoagulation therapy was performed, but left renal function was destroyed completely. Excessive and prolonged retraction of the renal artery with vascular tape may have resulted in this unfortunate complication.

[Voiding condition in elderly males examined prostate cancer screening in total health check and the effect of subjective urinary symptoms on quality of life].

PURPOSE: We investigated the prevalence of lower urinary tract symptoms and the effect of subjective urinary symptoms on quality of life (QOL) in elderly males examined prostate cancer screening in total health check from April 1996 to March 1997. PATIENTS AND METHODS: A total of 922 eligible examinees 50 to 70 years old completed a questionnaire with questions worded similarly to those of the international prostate symptom score (I-PSS) and AUA Impact index score and so on. RESULTS: The prevalence of moderate to severe symptoms was 19.6%, which increased with age. I-PSS was well correlated aging but not prostate size. The most prevalent symptoms were nocturia (61.1%), frequency (50.0%) and weak stream (47.7%). There was good correlation between symptom severity and QOL and AUA Impact index scores. While QOL was correlated with obstructive and irritative symptom scores, wish for treatment was associated mainly with irritative symptoms by multiple regression analyses. However, some examinees (15.5%, 28/181), who had moderate to severe symptoms, did not feel a decrease of QOL in daily life. CONCLUSIONS: A large percentage of elderly men 50 years old or older experienced symptoms. However, subjective urinary symptoms did not always correlate with QOL in some individuals. We should independently consider not only symptom severity but also QOL and AUA Impact index score in clinical decision making.