Search

A 77-year-old woman was referred to our hospital with complaints of fever and left chest pain. Computed tomography showed left pyothorax and left pyonephrosis with left ureter calculus. After admission, drainage of the left thoracic cavity was performed and she was treated with antibiotics. On the third hospital day, debridement for pyothorax was performed because her condition had not improved. During surgery, we found perforation of the diaphragm, and abscess appeared from the perforated area. We suspected that perforation of the diaphragmfromthe left pyonephrosis caused left pyothorax, and performed left nephrectomy. After the operation, relapse of the pyothorax and surgical wound infection occurred, but her condition improved and she discharged on the 46th hospital day. Relapse of the abscess has not occurred.

A 14-year old female was referred to our hospital with the chief complaint of microhematuria. A bladder tumor of the right wall was detected by abdominal ultrasonography and cystoscopic examination. Transurethral resection of the bladder tumor was performed. Pathological examination showed urothelial carcinoma, low grade (grade 1＞grade 2), pTa. She was free of recurrence at 2 years and 5 months postoperatively.

Megalo-type isomaltosaccharides are an enzymatically synthesized foodstuff produced by transglucosylation from maltodextrin, and they contain a mid-chain length polymer of D-glucose with α-1,6-glycoside linkages. The injection of a solution of megalo-type isomaltosaccharides (1–4%(w/v), average DP = 12.6), but not oligo-type isomaltosaccharides (average DP = 3.3), into the intestinal lumen dose-dependently reduced the transport rates of tight junction permeable markers in a ligated loop of the anesthetized rat jejunum. Application of the megalosaccharide also suppressed the transport of tight junction markers and enhanced transepithelial electrical resistance (TEER) in Caco-2 cell monolayers. Cholesterol sequestration by methyl-β-cyclodextrin in the Caco-2 monolayers abolished the effect of megalosaccharide. Treatment with anti-caveolin-1 and a caveolae inhibitor, but not clathrin-dependent endocytosis and macropinocytosis inhibitors, suppressed the increase in TEER. These results indicate that isomaltosaccharides promote the barrier function of tight junctions in the intestinal epithelium in a chain-length dependent manner and that caveolae play a role in the effect. Megalo-type isomaltosaccahride interactｓ to caveolae components, and initiates signals to the tight junction for enhancing barrier function of the intestinal epithelium.

Phialemonium curvatum, an endophytic fungus isolated from the leaves of Passiflora edulis was cultured in potato dextrose broth (PDB) media and chromatographic separation of the EtOAc extract of the broth and mycelium led to the isolation of 4-hydroxybenzoic acid (1), 3-indole acetic acid (2), solaniol (3), uracil (4), uridine (5) and glycerol (6). Compound 2 showed a weak antifungal activity against Cladosporium cladosporioides. This is the first report of the isolation of the endophytic fungus P. curvatum from P. edulis and complete 13CNMR assignments of 3.

The C-26 amino group of tomatine, a representative Solanaceae steroidal alkaloid, is introduced in an early step of its biosynthesis from cholesterol. We recently proposed a transamination mechanism for the C-26 amination as opposed to the previously proposed mechanism involving a nitrogen nucleophilic displacement. In the present study, a deuterium labeled C-26 aldehyde, (24,24,27,27,27-2H5)-3b- hydroxycholest-5-en-26-al, was synthesized and fed to a tomato (Solanum lycopersicum) seedling. LC– MS analysis of the biosynthesized tomatine indicated that the labeled aldehyde was incorporated into tomatine. The finding strongly supports the intermediacy of the aldehyde and the transamination mech- anism during C-26 amination.

We performed ultrasound-guided biopsies on 14 patients having tumors that were difficult to distinguish as benign or malignant on computed tomography. The study took place from January 2004 to December 2011. Of the 14 tumors biopsied, 12 were malignant, 1 was benign, and 1 was a sampling error. Of the 12 malignant tumors, 7 were primary kidney carcinomas. Six patients received radical or partial nephrectomies, and all had a good prognosis. Three patients with metastatic kidney cancers died of the primary disease. Eleven patients (85.5%) were diagnosed pathologically by biopsies, allowing us to decide the course of treatment. However, because our tests also revealed one sampling error and one unspecified cancer, we determined that there are limitations to a renal biopsy.

A 64-year-old man presented to our emergency room with right back pain on July 10, 2009. At the emergency room, abdominal enhanced computed tomography revealed a cystic lesion in the retroperitoneum. Then he was referred to our department. We performed percutaneous drainage of the retroperitoneal lesion and aspirated white pus. The retroperitoneal cystic lesion proved to be an abscess. Microscopic examination of a Gram stained specimen of the abscess revealed gram-positive bacillary fragments ; therefore, we suspected the pathogen to be Nocardia. He had a history of chronic glomerulonephritis and had received treatment consisting of 20 mg prednisolone, and 75 mg cyclosporine per day. He was regularly visiting the department of cardiovascular for follow-up of chronic heart failure. On the day before his visit to our emergency room, his chest X-ray medicine had revealed a nodular shadow. Then he was referred to the department of respiratory medicine and was scheduled to receive a bronchoscopy later. We suspected the nodule of the lung also to be an abscess of Nocardia. Later, head computed tomography (CT) revealed a brain abscess the pathogen of which was Nocardia. Nocardia is a filamentous, gram-positive, branched bacterium and classified as an aerobic actinobacteria. Nocardia species are difficult to diagnose due to non-specific clinical and histological manifestation. We report this case of disseminated nocardiosis presenting as retroperitoneal abscess. The disseminated nocardiosis was diagnosed without delay by percutaneous drainage and appropriate treatment was provided.

We report a case of mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney. A 68-yearold female consulted a primary hospital with a chief complaint of back pain. Computed tomography revealed the tumor of the left kidney, so she was referred to our department. The tumor, 45×42 mm in length, was slightly enhanced, and that had well-defined margins. We performed radical nephrectomy. Pathological findings suggested MTSCC. MTSCC is a rare type of renal cell carcinoma composed of a combination of low-grade tubular cuboidal cells and spindle cells in a mucinous stroma. The immunohistochemistry is effective in its diagnosis.

We prospectively studied the usefulness of chlormadinone acetate (CMA) as an alternative therapy for prostate cancer relapse after combined androgen blockade (CAB) therapy. Sixteen patients with relapsed prostate cancer after treatment with CAB, including surgical or medical castration and nonsteroidal antiandrogens, 80 mg bicalutamide daily or 375 mg flutamide daily, were enrolled. After discontinuing the antiandrogen for evaluating the patient for the antiandrogen withdrawal syndrome, we administered 100 mg CMA daily as alternative antiandrogen andestimatedits effect. Four patients showeda ＞− 50% decline in prostate-specific antigen (PSA) levels andanother 4 patients showeda ＜50% decline in PSA levels but residual 8 patients showed no decline in PSA levels. In 8 patients with a decline in PSA levels, the median duration of alternative CMA therapy was 11.4 months. Patients with a PSA level of ＜1 ng/ml at the start of CMA therapy showed the tendency of decline in PSA levels. In contrast, patients with a nadir PSA level of ＞− 0.2 ng/ml during pretreatment showed no effectiveness of the alternative CMA therapy. The alternative CMA therapy may be useful in a part of patients with prostate cancer relapse after CAB therapy.

60歳女。患者は左腰背部痛を主訴とした。CTで左水腎症, 左尿管拡張を認め, 諸検査から後腹膜線維症も疑われたが, 尿細胞診はIIIaであり, 不整に造影される画像所見等や異常血管等も認められないことから否定的であった。しかし, 左腎盂から尿管の悪性疾患も否定できず, 患者の希望もあって生検は施行せずに左腎尿管摘出術が行われた。その結果, 腎盂から尿管にかけて長さ4cmの硬い腫瘤があり, 尿管癌が疑われた。一方, 腎実質等周囲への浸潤はみられず, 病理組織学的所見でも炎症性偽腫瘍に特徴的な紡錘細胞ははっきりみられなかったが, 炎症性細胞浸潤やリンパ濾胞形成等の炎症所見は認められ, その修復過程でできた腫瘍と考えられた。以上より, 本症例は腎盂から尿管にかけて発生した炎症性偽腫瘍と診断され, 発生部位が上部尿路であったこともあり, 本疾患に特徴的なanaplastic lymphoma kinase蛋白の発現は得られなかった。尚, 炎症性偽腫瘍が腎盂, 尿管に発生した症例は稀で, 検索した限り我が国では17例の報告が確認されるのみである。, A 60-year-old woman underwent detailed examinations for hepatic disorders and pancreatic tumor at the Department of Internal Medicine. A tumor mass in her left renal pelvis and a thickened wall in her left ureter were observed on computed tomography (CT) and magnetic resonance imaging (MRI) images. Retrograde ureteropyelography and drip infusion pyelography images showed a stenosis in 1 vertebral body from the left ureteropelvic junction. Urinary cytology finding was class III-a; however, malignancy could not be disregarded. Since the patient continued to experience severe dorsal pain, a left nephroureterectomy was subsequently performed at the patient's request. Pathological tests showed no malignant findings, and based on the chronic pyelonephritis, we diagnosed her condition as an inflammatory pseudotumor. Not many inflammatory pseudotumors are found in the urinary tract, and even fewer are manifest in the renal pelvis and ureter. Although inflammatory pseudotumors are generally benign, cases of repeated local recurrence exist. Therefore, a meticulous follow-up observation is required.

症例1(76歳)。頻尿, 腰痛を主訴とした。症例2(78歳)。C型肝炎の経過観察中であった。細胞診がそれぞれIIIbとVであったことから癌性胸水の診断はできていたが, 腫瘍マーカー検査でPSAの測定はなされておらず, 特に症例1では原発巣の同定に時間を要した。経直腸的前立腺生検を施行し, 前立腺癌の診断を得た上, MAB療法を開始したが効果が不十分で, EMPへ変更した。両症例ともいったんはPSAが低下を認めることもあったが, その後上昇し, 症例1は胸水増悪, 全身状態悪化により治療開始14ヵ月後に癌死した。一方, 症例2は副作用のため化学療法の継続を望まず, PSAが上昇するに従って胸水が徐々に増加し, 治療開始16ヵ月後に癌死した。, Prostate cancer is rarely detected from abnormal chest radiographs. We report two cases of prostate cancer detected from pleural effusion. Case 1 is a 76-year-old man who consulted the department of internal medicine of our hospital with dyspnea and abdominal fullness. Pleural effusion and multiple hepatic tumors of unknown origin were pointed out, but he refused any further investigation or treatment for them. Six months later, he consulted a family doctor with urinary frequency and lumbago. Increased serum prostate specific antigen (PSA) level to 864 ng/ml was recognized, then he was referred to our department. Under diagnosis of prostate cancer, T4NOM1c, maximal androgen blockade (MAB) was performed. Serum PSA level was decreased once to 8.1 ng/ml, but then rose gradually and he died 13 months after the beginning of the therapy. Case 2 was a 78-year-old man who was referred to our department to determine the origin of carcinomatous pleuritis detected in a routine general check up of hepatitis C. The serum PSA level was increased to 12, 900 ng/ml, and the diagnosis was prostate cancer, T3aNOM1c. Although MAB was performed, the serum PSA level did not decrease markedly. He died 16 month after the beginning of the therapy.

1998～2003年の腹腔鏡下副腎摘除術50例52副腎(男17例・女22例・中央値48.5歳)を報告した。開腹術に移行したのは2例で, それぞれ被膜動脈の損傷, 肝臓後面への鉗子食い込みによる出血であり, 本術式導入後2例目と6例目であった。術中・術後の合併症は, 副腎への切れ込みを毎年認めたが, 腫瘍そのものに対する損傷はなく, 臨床的に問題なかった。手術時間は1998年が平均263分, 2003年が173分と経験の蓄積に伴い短縮した。行程別にみると, 気腹から副腎遊離までの最重要過程は2000年以降135～140分と安定していた。手術時間と患者背景因子との関連では, BMI別では差がなく, 左右では左がやや短く, 腫瘍径2.6cm以上群は未満群よりも短かった。疾患別では原発性アルドステロン症が234.2分と最も長く, Cushing症候群との間に有意差を認めた。術後経過を2000年以前の開腹術24例と比較すると, 歩行開始や経口摂取開始などは有意に早く, 鎮痛剤使用回数は有意に少なかった。, We performed 50 laparoscopic adrenalectomies during the period from 1998 through 2003. We report our experience and the outcomes of this procedure, which has become a standard surgery for adrenal tumors. In most cases, the transperitoneal approach was used. In 48 cases, laparoscopic adrenalectomy was performed successfully. However, in two cases, the operation was converted to an open procedure because of bleeding. As our experience with laparoscopic adrenalectomy increased, operation time decreased. Laparoscopic adrenalectomy should be used more widely in the future.