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A 42-year-old male had intractable hyperkinetic seizure since childhood. Bottom-of-sulcus dysplasia was shown by MRI to be most likely an ictal focus, whereas ictal semiology suggested possible focus in the left frontal cortex. Scalp-recorded EEG could not delineate ictal EEG change at all partly because of violent hyperkinetic seizure, and thus intracranial EEG study by epidural electrodes was conducted as the best procedure for the safety concern. It showed ictal focus over the bottom-of-sulcus dysplasia and thus it was completely resected with seizure free more then 20 years until now. It was concluded that epidural electrodes are regarded as safe invasive recording method especially for violent hyperkinetic seizure, and that can provide us with essential information before epilepsy surgery.

It is now recommended that magnetic resonance imaging (MRI) or computed tomography (CT) be carried out in all patients with at least partial- and hopefully also generalized epilepsy to help identify intracranial lesions, such as hippocampal sclerosis, focal cortical dysplasia, brain tumor, cavernous malformation, and arteriovenous malformation. In order to identify epileptic focus, other neuroimaging tools, such as positron emission tomography (PET), single photon emission computed tomography (SPECT), and magnetoencephalography (MEG), are also useful, because an epileptogenic area is not necessarily located within these intracranial lesions. With regard to epilepsy surgery, neuroimaging is also required for the identification of functionally essential cortices, such as motor and language areas. MEG and functional MRI are noninvasively, and tractography with diffusion-weighted imaging (DWI) is also useful for visualizing relevant white matter tracts. Recently, it has been reported that the cortico-cortical network plays an important role in preservation of brain function. Thus, cortico-cortical evoked potentials (CCEP) and resting state fMRI are candidate methods to help clarify brain network. While good seizure control is an important treatment outcome for patients with intractable partial epilepsy, the preservation of brain function is equally important. For this reason, further development and clinical application of sophisticated imaging technique are required.

We report a 31-year-old patient who suffered from the left foot motor seizure since 6 years of age. In addition to spontaneous seizures, the seizures tended to be triggered by somatosensory stimulus to the left foot. Recently, he developed irregular myoclonic jerks of the left foot. Neurologically, he had mild impairment of fine movements of the left foot, but otherwise no weakness or sensory disturbance was noted. Interictal spikes were frequently recorded at the vertex region, where ictal discharges also started during the video-EEG monitoring. Electrical stimulation of the left tibial nerve evoked giant cortical components of somatosensory evoked potentials and C-reflex. Magnetoencephalographic study of both interictal and jerk-locked averaged spikes located the equivalent current dipole of both activities at the left foot primary somatosensory cortex (SI), where 3 tesla MRI revealed a focal abnormality consistent with focal cortical dysplasia. The present non-invasive investigation suggests that focal cortical dysplasia at SI could manifest intrinsic, autonomous, epileptogenicity as well as extrinsic, stimulus-sensitive, hyperexcitability, which are clinically manifested as spontaneous seizures and cortical reflex myoclonus, respectively.

We conducted a prospective randomized controlled study on the prophylactic effects of short-term intravesical instillation of pirarubicin (THP) against recurrence to determine the effective administration schedule. All patients gave their informed consent. The subjects included bladder cancer patients who had pTa or pT1, and G1 or G2 cancer, and became tumor-free after transurethral resection of the bladder tumor (TUR-BT). After dissolving 30 mg of THP into 5 ml of distilled water, physiological saline was added to adjust the total volume to 50 ml, which was then instilled into the bladder, and was retained for 5 minutes. The schedule of instillation was for daily for 7 consecutive days from the day of TUR-BT and subsequently once a week for 10 weeks, 17 times in total for Group I, and once every two weeks for 6 months (12 times) starting 2 weeks after TUR and subsequently once a month until one year had passed after surgery (6 times), 18 times in total for Group II. The total number of cases was 69 (36 in Group I, 33 in Group II). The tumor-free ratios determined by the Kaplan-Meier analysis were 93.9% in Group I and 72.7% in Group II for one year, and 86.8% in Group I and 59.5% in Group II for two years. There was a statistically significant difference in the tumor-free ratios between the two groups by the generalized Wilcoxon test and the Log rank test (p = 0.0145 and 0.0107, respectively). Multivariated analysis using Cox's comparison hazard model produced p-values of 0.0002, 0.0007, 0.0009 and 0.0040 in the order of therapeutic mode, initial onset/recurrence, stage and number of tumor. Adverse events that forced discontinuation of the therapy for a while occurred in 4.3%. These results demonstrated that short-term intensive intravesical instillation of THP immediately after TUR-BT was a safe and effective therapy.

One approach to the treatment of obstructive azoospermic cases in whom either vasovasostomy cannot be performed or the vas deferens is absent is to construct an artificial spermatocele in the epididymis. By using this method to recover sperms for use in AIH, we have succeeded in achieving pregnancy in only 2 of 35 cases, leading us to investigate the fertility of the recovered sperms. Sperm fertility was investigated by the hypoosmotic swelling (HOS) test, observation by confocal laser-scanning microscope (CLSM), flow cytometry and hamster egg sperm penetration test. The percentage of swollen sperm determined by the HOS test was 15.0-83.3%, with a mean of 47.6 +/- 16.1%, significantly lower than the values of the normal group and the infertile male group, excluding cases of obstructed azoospermia. Examination by confocal laser-scanning microscope of samples stained with PI and FITC-PSA or PI and FITC-Con A stain revealed viable and dead spermatozoa as well as viable and dead acrosome-reacted spermatozoa. In addition, fertility was evaluated from the distribution of spermatozoa in each area from the flow cytometry percentage. This method was shown previously to be useful for the evaluation of fertility as it demonstrated the presence of numerous spermatozoa in the fertile area of cases who did not succeeded in pregnancy. The hamster egg sperm penetration test yielded a fertility rate of 0-25% with a mean of 8.2 +/- 10.0%, which was significantly lower than the value of the normal group, but was not significantly different from the infertile group. The findings of this study indicated that the fertility of epididymal sperms is low, thereby pointing to the need for studies to improve the materials used in the artificial spermatocele as well as the method of sperm recovery. Furthermore, our findings suggest that flow cytometry may be used to select the epididymal sperms with the highest fertility for sperm recovery.

Tranilast, an antiallergic drug, is well known as a causal drug of cystitis, and a report is made here of our experience of 1 case of drug-induced cystitis ascribable to ketotifen fumarate. A 13-year-old female had been taking anti-asthmatic drugs orally since the onset of athmatoid attacks, from age of 5. The attacks intensified from the age of 12, because of this she began to take various anti-asthmatic drugs orally. She visited another hospital, due to pollakisuria, in November, 1990, and received treatment for cystitis. However, the symptoms were not alleviated, and she visited our department on January 9, 1991. By urinalysis, large counts of leukocytes and erythrocytes were observed in a visual field of the sediment. Remarkable reddening was observed over the urinary bladder in the patient's cystoscopic findings. Treatment was given at our department, on an outpatient basis, with various antibacterial drugs for approximately one month, but her symptoms were not alleviated, pollakisuria and aseptic pyuria persisted. The patient had never taken tranilast; oral intake of ketotifen fumarate and saibokutou was discontinued on February 13, due to a suspicion of drug-induced cystitis, and her symptoms subsequently disappeared. On February 22, she took ketotifen fumarate orally again, on her own, due to asthmatoid attack, and her symptoms returned. The oral intake of ketotifen fumarate was again discontinued, and alleviation of the symptoms and normalization of the urinary findings were again observed. As a result, lymphocyte stimulation tests on all the drugs the patient had ever taken, only ketotifen fumarate turned out to be positive.(ABSTRACT TRUNCATED AT 250 WORDS)

A male aged 48 visited our department on October 17, complaining of swelling of his left scrotal content from July, 1990. Physical examination showed the testis to be swollen to the size of a chicken egg, and ultrasound examination disclosed the swelling to be solid and nodular. Left high inguinal orchiectomy was performed on October 29. The testis extirpated was 50 x 40 x 45 mm in size and weighted 80 g; the gross appearance of the cut surface of the testis was nodular with grayish-white color. The lesion was proved to be spermatocytic seminoma histopathologically, but no hemorrhage or necrosis was observed. Radiation in the dose of 36 Gy was given over the left hypogastrium and paraaortic region in 36 Gy each. The patient subsequently did will and has been followed up in our outpatient clinic without evidence of recurrence as of 10 postoperative months. This patient was the 19th reported case of spermatocytic seminoma in Japan. However, General Rules for Clinical and Pathological Studies on Testicular Tumors explain that spermatocytic seminoma is usually seen in a pure form, unassociated with other types of germ cell tumors, making our case actually the 17th case of this particular seminoma if spermatocytic seminomas combined with other germ cell tumors are exclude from the statistical analysis. Reports of spermatocytic seminoma thus defined are reviewed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

A 62-year-old man with Wegener's granulomatosis developed sclerocorneal ulcer. The general condition of the patient became well with steroid and presented cyclophosphamide therapy, he developed sclerocorneal ulcer. The sclerocorneal ulcer was present at the nasal limbus of the right eye. The ulcer was marked and presented descemetocele. Although lamellar keratoplasty was performed, the scleral ulcer recurred after two weeks. Excision of the affected sclera and autoscleroplasty was performed. The ulcer disappeared after 6 months, and the corneal graft was covered with corneal epithelium and conjunctiva. Ten months after autoscleroplasty was performed, a sclerocorneal ulcer was again recurred. We performed lamellar excision of the affected corneal area, resected the adjacent conjunctiva and performed keratoepithelioplasty. These surgical procedures were effective in preventing perforation of the cornea. Specular microscopic study of the corneal epithelium revealed nucleated epithelium and large epithelial cells. The endothelium appeared normal.

One hundred and forty-four fungal isolates were obtained from diseased Paeonia albiflora Pall. var. trichocarpa Bung., Astragalus membranaceus Bung., Lithospermum erythrorhizon Sieb. et Zucc., Ledebouriella seseloides Wolff and Bupleurum falcatum L. which were collected in the test field of Tsukuba Medicinal Plant Research Station, National Institute of Hygienic Sciences. Most of them were identified into 15 genera containing 8 species. Fungal species presumed to be pathogens of the host plants were as follows: Cladosporium paeoniae, Pestalotia paeoniicola, Glomerella cingulata, Hainesia lythri, Guignardia sp. and Alternaria sp. from P. albiflora, Fusarium spp., Rhizoctonia spp. and Neocosmospora vasinfecta from A. membranaceus, Colletotrichum gloeosporioides from L. erythrorhizon, Rhizoctonia sp., Fusarium spp., Phoma sp. and Pyrenochaeta sp. from L. seseloides, and Fusarium sp., Alternaria alternata, Phyllosticta sp., Phoma sp., Phomopsis sp. and C. gloeosporioides from B. falcatum. Roots of B. falcatum were found to be parasitized by Meloidogyne sp.

The patient was a female aged 18. Hematuria was discovered at an examination two years previously at which time the patient was complaining of right lumbar pain. The patient visited our hospital with a chief complaint of right abdominal tumor in June, 1988. A retroperitoneal tumor, 77 X 45 mm in size, was observed by CT and ultrasonic examination, and the right kidney was in hydronephrosis. An operation was performed in September, 1988, based on a diagnosis of retroperitoneal tumor and hydronephrosis. The tumor was seen to have involved the right ureter. Subsequently the tumor was surgically removed; right total nephroureterectomy and partial cystectomy were performed at that time. The removed tumor was 90 X 70 mm in size and 120 g in weight; it was histopathologically diagnosed as extraskeletal Ewing sarcoma. A systemic examination was carried out postoperatively, but no abnormalities were observed. As of September, 1990, the patient had had no recurrence and was being kept observation on an outpatient basis. There have been a total of 210 case reports regarding extraskeletal Ewing sarcoma published worldwide, including our case and 26 cases in Japan, so far as we know. However those of a lesion of retroperitoneal origin are extremely rare, numbering only 11 cases worldwide and 2 Japan. Herein we report our case of extraskeletal Ewing sarcoma with reference to the other 209 cases reported in the literature to date.

A clinical trial was performed with the tranquilizer Bromazepam on 39 patients undergoing diagnosis of psychogenic impotence, and the drug effect was evaluated according to the criteria based on our protocol. The protocol specifies 8 tests (1 for libido, 4 for erection, 2 for ejaculation, 1 for orgasm) which are scored according to an arbitrary logarithmic scoring system. At the end of the study the points made in the 8 tests were added to obtain the total score as the basis for evaluation of the overall drug effect. After treatment all tests showed an improvement, and the improvement in erection during masturbation, reflective erection, and condition of ejaculation was statistically significant. The total score also improved from 16.77 +/- 2.62 (mean +/- S.D.) before treatment to 11.42 +/- 1.96 after treatment, and the change was again statistically significant (P less than 0.05). The rate of satisfaction as a subjective symptom of improvement also increased from 25.38 +/- 4.40% to 39.10 +/- 4.53%. The results of the present study provide evidence to indicate that Bromazepam is beneficial for psychogenic impotence.

Between May, 1985 and September, 1987, percutaneous nephrolithotripsy (PNL) and transurethral ureterolithotripsy (TUL) have been performed at our hospital and five affiliated hospitals. We report on the therapeutic results of 216 cases treated during this period. PNL and TUL were performed 168 times on 120 patients (119 males and 41 females) and 57 times on 56 patients (35 males and 21 females), respectively. Rate of success with PNL was 80.7% (103/130) for renal calculus, 85.7% (18/21) for upper ureteral calculus, and 47.1% (8/17) for middle-lower ureteral calculus. Rate of success with TUL was 57.9% (33/57). Of these, cases of ureteral lower edge calculus showed the lowest rate of success, being 33.3% (2/6). Complications of the cases undergoing PNL and TUL were: ureteral damage in 13; hemorrhage in 6; renal pelvic damage in 4; ureteral lower edge stenosis in 3; pyrexia in 3; cardiac insufficiency in 2 and retention of perfusate in posterior peritoneal cavity, pneumonia and renal insufficiency in 1 case each.

We describe the usefulness of topical application of thrombin as a hemostatic aid in prostatic surgery. We used a specially designed 3-way bag catheter, one way of which opened to the prostatic fossa. After enucleation of the prostate suprapubically, we inserted the bag catheter into the bladder before any hemostatic procedure was performed on the prostatic fossa, inflated the bag, gently pulled down the catheter against the prostatic fossa, and then injected the thrombin solution (5,000 units/5 cc. X 2) into the fossa. Fifty patients were randomized into two groups; the "thrombin" method group and the hemostatic "ligature" group, and compared. The "thombin" method group showed statistically significant superiority to the "ligature" method group in reduced operation time and operative bloodloss. On the contrary, the duration of postoperative hematuria was longer with the "thrombin" method but not significantly. Even the prolonged duration of hematuria, however, produced no clinical problems. Hypofibrinogenemia and poor conditions of drug storage lowered its efficacy. These points should be remembered when using thrombin.

A 40-year-old pregnant woman, who suffered a continuous episode of fever and anemia since the 26th week of pregnancy, was referred to our clinic for evaluation of her left flank pain and tumor. As retroperitoneal tumor was suspected by retrograde pyelography, sonography and CT, translumbar tumorectomy was performed under general anesthesia. The histological diagnosis was retroperitoneal abscess.

We treated 53 patients for male infertility with TSUMURA - Hachimijiogan given as a daily dose of 7.5 g for 144 days on the average. The sperm density was improved by administration to 10 X 10(6)/ml or more in 22 patients (41.5%) and lowered to 10 X 10(6)/ml or more in only 2 patients (3.8%). The sperm motility was improved by 10% or over in 29 patients (54.7%) as compared with 5 patients (9.4%) in whom it was lowered by 10% or more. The sperm motile efficiency index ( SMEI ) was improved in 40 (75.5%) of the 53 patients. Statistically significant differences were noted in the improvement in sperm density, sperm motility and SMEI . By contrast, there was no difference in semen volume, sperm morphology or sperm agglutination between the pre- and post- treatment periods. During the period of treatment, the wives of 4 patients (7.5%) conceived children. These results suggest that TSUMURA - Hachimijiogan is effective for male infertility to a certain extent and that clinical trials on its use for male infertility may be meaningful.