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Computed tomography (CT) performed for a 75-year-old man as a follow-up examination for deep vein thrombosis in October 2010 revealed a left adrenal mass (diameter, 8 mm). In December 2012, the adrenal mass increased to 28 mm in diameter, and he was referred to our department. Several blood examinations revealed that the adrenal mass was non-functioning, and only peripheral lesions were observed to be enhanced by using CT in the arterial phase. Malignancy was suspected due to the irregular shape and growth of the mass, and left adrenalectomy was performed in February 2013. The histopathological diagnosis was adrenal mycobacteriosis, and clinical diagnosis was adrenal tuberculosis. No other tuberculosis infection-related lesion was detected, and the patient was treated with multidrug antituberculous chemotherapy.

A 43-year-old man came to our clinic complaining of infertility and semen analysis showed azoospermia. Analysis of chromosomes showed a mosaic 45, XO/46, X, ＋mar1/46, X, ＋mar2 karyotype, and the marker chromosomes were considered to be two kinds of ring Y chromosomes. Y chromosome microdeletion analysis showed partial deletion of Azoospermic Factor (AZF) a, and complete deletion of AZFb and AZFc. The patient gave up having a child because these results indicated that no sperm would be collected even if Testicular Sperm Extraction (TESE) were performed.

A 75-year-old man with advanced bladder cancer (cT4N1M0) received three courses of systemic chemotherapy with Methotrexate, Epirubicin and Nedaplatin (MEN). His metastatic lymph node completely disappeared. We performed total cystectomy. Three months after the surgery, he complained of neck pain and nausea. Brain magnetic resonance imaging (MRI) revealed a 3 cm tumor in his right cerebella and a 5 mm tumor in left parietal lobe. He underwent surgical resection of the right cerebellar tumor and a gamma knife therapy for the left parietal tumor. Pathological diagnosis was metastatic urothelial carcinoma. We performed three additional courses of chemotherapy of MEN. He has been well without local recurrence or distant metastasis for 18 months.

We report a case of metastatic micropapillary variant of the bladder that progressed from low grade non-muscle invasive bladder carcinoma. Lung, para-aortic and pelvic lymph nodes metastatic lesions were found in a 62-year-old woman, who had been followed due to non-muscle invasive bladder carcinoma. The bladder wall was found to be thick by computerized tomography (CT). She had had transurethral resection of bladder tumor (TURBT) at 60 and 61 years old, followed by intravesical therarubicin and bacille Calmette-Guérin therapy, respectively. Both TURBT specimens showed low grade, non-muscle invasive urothelial carcinoma. The thickened bladder wall was resected transurethrally and the pathological examination revealed that the recurrent tumor was entirely composed of micropapillary variant component. There must have been tiny lesions of a micro papillary variant component after the second TURBT. Several reports suggest that intravesical BCG therapy was ineffective for micropapillary variant. So the UC component was substituted for micropapillary component.

A right renal tumor was incidentally found in a 38-year-old woman by annual medical check up. She visited our hospital for further examination and treatment. She did not show typical symptoms of carcinoid. A computed tomography (CT) revealed a calcified solid tumor in the upper portion of the right kidney. The tumor was 6.0 cm in diameter and was not enhanced in either early or late phase. There was no evidence of extrarenal invasion or distant metastasis. Based on a clinical diagnosis of stage 1 renal cell carcinoma, laparoscopic nephrectomy was performed. The pathological diagnosis was renal carcinoid tumor. The tumor had trabecular and ribbon-like structures with a thin fibrovascular stroma. Immunohistochemicaliy, the tumor cells stained positive for chromogranin A, synaptophisin and CD56. The cell proliferation rate was estimated to be under 1% with Ki67 staining. To find the primary lesion, we performed upper and lower gastric endoscopy and chest computed tomography, but could not find any/other carcinoid tumors. At 1-year follow up, she had no evidence of local recurrence or metastasis.

We treated the malocclusion of two boys having a germinated tooth in the incisor region of maxilla. In case 1, the germinated tooth was located at the right lateral incisor, in case 2, at the left central incisor region of maxilla. The X-ray and CT examinations revealed that the germinated tooth was united by enamel and dentin and the dental pulp cavity was joined in both cases. So we carried out treatments to avoid pulpectomy in both cases; the germinated tooth aligned in the upper dental arch without saparating of the twin teeth. The crown of the germinated tooth was very large, so this tooth was impacted and/or erupted in dislocation due to a shortage of space for the eruption. Therefore, it is necessary in such a patient to establish an individually normal occlusion by controlling the eruption of the permanent tooth, furthermore considering the reshaping, extraction, and the dental prosthesis treatment by the long-term follow up.

Though it has been reported that osteoblasts perceive extracellular calcium levels and regulate the differentiation and function of osteoclasts, the details of its mechanism of calcium perception or of its genetic expression system mostly remains unclear. In the present study, therefore, the influence of a high-calcium environment on osteoblasts was examined from the expressions of RANKL and CaSR mRNAs as well as from the formation of osteoclasts following cocultures. The identification of CaSR was made by the immunohistochemical staining method using rat alveolar bones with experimental tooth movement. On the third and seventh days after manipulation, both osteoclasts and osteoblasts showed CaSR positive reaction on the compressed side of the alveolar bones. On the other hand, CaSR positive reaction was observed only for osteoblasts on the tension side of the alveolar bones, though the reaction was weak. In the subsequent experiment using an osteoblast-like cell line (SaOS-2 ), PT-PCR was performed by changing the calcium concentration in the cultured solution from 1.8 to 2.5, 10 and 40 mM and further by treating with 0.1 and 1.0 μM of ionomycin. The PCR products of RANKL and CaSR mRNAs were then analyzed. The expressions of RANKL and CaSR mRNAs decreased in a calcium concentration dependent manner. When SaOS-2 cells were treated with ionomycin, RANKL mRNA expression increased in a dose dependent manner. However, CaSR mRNA expression increased at 0.1 μM ionomycin but showed almost no difference at 1.0 μM as compared with the untreated level. In order to examine the effect of calcium on the differentiation of osteoclasts, SaOS-2 cells were cocultured with a human myeloid leukemia cell line (HL-60). Total RNAs were extracted after SaOS- 2 cells pretreated with calcium were cocultured with HL-60 and after SaOS-2 cells pretreated with lα,25(OH)_2D_3 were cocultured with HL-60 under the presence of calcium, and the amount of tartrate-resistant acid phosphatase (TRAP) mRNA expression was examined by RT-PCR, Simultaneously, the number of osteoclasts that appeared was counted. As a result, the expression of TRAP mRNA increased in a dose dependent manner up to the calcium level of 2.5 mM but decreased at levels above it. The number of osteoclast-like cells showed a similar pattern to the expression of TRAP mRNA. In the case of SaOS-2 cells pretreated with 1α,25(OH)_2D_3, the TRAP mRNA expression increased in a dose dependent manner up to a calcium level of 10 mM but the expression at a calcium level of 40 mM decreased to a similar level observed at 1.8 mM. From the results mentioned above, it was suggested that a high extracellular calcium level in osteoblasts suppresses the expression of RANKL through CaSR which exists in the cell membrane and further suppresses the differentiation of osteoclastic precursors to osteoclasts.

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27丁 ; 27.1×18.5cm, 刊本, [京都] : 中野道也 , 正保4 [1647], 本書名は題簽より, 藤原公任編, 題簽の巻次: 三. 兼輔, 敦忠, 公忠, 著者・編者は「日本古典籍総合目録データベース」より, 最終巻15の刊記に「正保四丁亥暦八月 書林中野道也繍梓」とあり, 四周単辺無界11行 (内匡廓: 21.6×16.4) ; 朝鮮綴, 印記: 「三碧樓藏書印」(朱印), 「北中瀬」, 全15巻帙入