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The state of health of old patients with spinal cord injury (SCI) was investigated to clarify the disorders that they are presently suffering from. A questionnaire was sent by mail to 668 patients with SCI living in western Japan. Valid answers were returned from 448 (67%), and they were divided into a young group (160 patients aged 18-39 years), middle-aged group (193 patients aged 40-59 years), and elderly group (95 patients aged 60-73). About 30% in the young group answered that they were ill or worrying about their health. This percentage was about 60% in the middle-aged and elderly groups. According to disease types, none of the young group had urological diseases except urological impairment or cardiovascular diseases, but many of the elderly group had urological tract infection, kidney diseases, cardiovascular diseases, and digestive diseases. Decubitus ulcer was reported in all groups. Urological diseases and decubitus ulcer were considered to be characteristic ailments of individuals with SCI. The elderly group was also characterized by a high incidence of adult diseases such as hypertension and diabetes mellitus. Therefore, the types of diseases and their frequency are considered to be different in older patients with SCI compared with the aged population in general because of the characteristic conditions of SCI in addition to adult diseases.

The purpose of this study was to clarify the effect of the level of spinal cord injury (SCI) and of daily exercise on the relationship between heart rate (HR) and oxygen uptake (VO2) in persons with SCI (PSCI) during an arm cranking exercise. Eighteen PSCI were divided into three groups according to the level of SCI; 4 quadriplegics (C6-C8), 7 high- level paraplegics (T3-T8), and 7 low-level paraplegics (T10-L2). In the relationship between HR and VO2, the higher the level of SCI, the smaller the slope of regression line, that means the HR at a given VO2 become larger as level of SCI was higher. Significant differences were found among these regression lines (P < 0.01). In addition, the regression lines between HR and VO2 in active persons tended to shift toward upper in comparison with those in inactive persons. The present investigation clearly shows that the HR-VO2 relationship in PSCI is remarkably influenced by the level SCI and physical training.

In patients with spinal cord injury, rectal temperature is difficult to use as body temperature due to impairment such as defecation disturbance. We developed an earphone type device to measure aural canal temperature that can be also used during exercise in patients with spinal cord injury and evaluated its usefulness. The subjects consisted of 11 healthy male students. They exercised for 30 minutes using an ergometer until the heart rate increased to 150-160 bpm. Aural canal temperature, rectal temperature, and non-contact tympanic membrane temperature were measured before, during, and after exercise. This device for the measurement of aural canal temperature was produced by cutting the tip of a commercially available earphone and connecting a thermocouple wire to it. This device is very small and causes no discomfort even during long wearing or inconvenience during exercise. The aural canal temperature obtained in this study was very stable compared with the rectal temperature or non-contact tympanic membrane temperature and thus may be useful for monitoring body temperature.

The purpose of this study was to investigate the effect of the level of spinal cord injury on work efficiencies of paraplegics during arm cranking exercise. Subjects were male paraplegics including seven high paraplegics (T3-T8) and seven low paraplegics (T10-L1, 2), and seven normal males. They performed arm cranking exercise at 0 and 30 watts. Work efficiencies of high paraplegics showed a little lower than others, although there were no significant differences among subject's groups. On the other hand, the pulmonary ventilation at a work load of 30 watts significantly increased in high paraplegics in comparison with low paraplegics and normal subjects. The somewhat low work efficiency of high paraplegics was attributable to the increased ventilation which yielded an increase in oxygen uptake.

We present a case of a 11-deoxycorticosterone (DOC)-producing adrenocortical tumor. A 55-year-old female was admitted to our hospital with the chief complaints of sustained hypertension and weakness of lower extremities. A laboratory study revealed a decrease in the serum potassium level and plasma renin activity, a normal level of plasma aldosterone and a significant elevation of plasma DOC and 18-OH-DOC levels. The plasma DOC level was increased by ACTH stimulation and was not suppressed by dexamethasone. The tumor appeared at a low intensity of the T1 weighted image of magnetic resonance imaging (MRI) and at a high intensity on the T2 weighted image. Left adrenalectomy was performed and histological examination revealed a benign adrenal adenoma. Postoperatively, the abnormal blood pressure, serum potassium level and plasma level of DOC and 18-OH-DOC became normal.

Daily energy expenditure (DEE) was evaluated seventeen male subjects with spinal cord injury (SSCI), who had active (N = 9) and inactive (N = 8) lifestyles, and in seven normal males. DEE was estimated from the mean 24-hr heart rate and heart rate-energy expenditure relationship determined in an arm cranking exercise. The DEE of SSCI on active days did not differ from those of normal subjects. On inactive days, SSCI had significantly lower DEE than on active days and than normal subjects. In contrast, the mean 24-hr heart rates of SSCI on active days and inactive SSCI were significantly greater than those of normal subjects, suggesting that SSCI, particularly inactive SSCI, exhibited a slight degree of tachycardia when compared to normal subjects. On inactive days, the DEE was fairly independent of the level of spinal cord injury. However, on active days, there was a clear tendency for SSCI with a low lesion level to have a higher DEE. Even if a SSCI with a high lesion level engaged in active sports, his DEE was relatively small. This lower DEE was largely attributable to the smaller functional muscle mass due to the limitation of physical activity.

We report a case of retrovesical fibrosarcoma with severe hypoglycemia. A 67-year-old man was admitted to our hospital with second recurrence of the retrovesical tumor with hypoglycemia. The episodes of hypoglycemia were accompanied by the advance of tumor size. Complete tumor resection with total cystectomy was performed on December 21, 1989, and the tumor was diagnosed histopathologically as fibrosarcoma. Soon after removal of the tumor, hypoglycemia disappeared and the patient has been well without local recurrence or distant metastasis for more than 20 months.

A case showing the regression of coronary atherosclerosis by the treatment with LDL-apheresis, was reported. The patient was a 67-year old female with heterozygous familial hypercholesterolemia. She had noticed the xanthelasma or left cubital xanthoma at the age of 50 years old. She was informed about her high serum cholesterol level (greater than 350 mg/dl), and the abnormal thickness of her bilateral achilles tendon at the age of 61 years. As her serum cholesterol level did not decrease sufficiently with several lipid-lowering drugs, she was referred to our hospital in order to obtain treatment for it by LDL-apheresis at the age of 66 years. LDL-apheresis was performed once every two weeks with drugs such as probucol, cholestyramine and pravastatin. Her coronary angiogram after two and half years of LDL-apheresis showed a decrease of the coronary narrowing in segment 1 and segment 13 (from 96.8% to 74.6% in segment 1, and from 81.5% to 61.7% in segment 13, respectively). The thickness of her bilateral achilles tendons had also decreased from 18 mm in the right and 19 mm in the left to 14 mm in both, after receiving LDL-apheresis for two and half years. It is suggested from the result of this case that the regression of coronary atherosclerosis could be expected after treatment with LDL-apheresis in hypercholesterolemic patients.

1. Retinol exerted a remarkable stimulating effect (approx. 260% increase), essentially similar to that (300%) of phytol, on the so-called esterase activity displayed by crude pancreatic lipase [EC 3.1.1.3] toward true solutions of esters, but none of the typical lipase activity toward emulsions of water-insoluble esters. 2. Comparison of the stimulatory effects of retinol derivatives on the esterase activity revealed that retinyl acetate was the most active, being sustantially similar in effect to retinol; retinal was fairly active, while retinoic acid, retinyl palmitate, and beta-ionone were far less active. 3. With various isoprenoid compounds, the efficiency of stimulation increased with the carbon chain length, attaining a maximum at 15 to 20 carbon atoms. Above this chain length the efficiency decreased rapidly. 4. Comparison of the effects of retinol and phytol on the esterase activity of various other lipolytic enzymes indicated that this kind of activator may be relatively specific to porcine pancreatic esterase activity.

Five hundred and nineteen patients with primary bladder cancer were treated between January, 1969 and December, 1984, 12 of whom had developed upper urothelial tumors. These patients had received various transurethral treatment for the primary bladder lesions, except for one patient who had undergone total cystectomy and ileal conduit diversion. Overall incidence of patients with upper urinary tract tumors following bladder cancer was 2.3%. The incidence of patients with treated bladder tumors (13.2%) for dye workers was higher than that for the general population (1.1%). The interval between initial treatment of the bladder tumor and diagnosis of the upper tract tumor ranged from 7 to 170 months (mean 70 months). The incidence of upper tract tumors increased with the passage of time. We conclude that the occurrence of upper urinary tract tumors following primary bladder cancers is promoted by nonspecific chemical irritants against the urothelium already made unstable by certain urinary chemical carcinogens.

Two cases of adenomatous polyps with prostatic type epithelium are reported. The first case was of a 62-year-old male suffering from asymptomatic hematuria. Cystoscopic findings showed an urethral tumor in the prostatic urethra. He was treated by transurethral resection of the prostate. The second case was of a 47-year-old male with complaints of hematuria and doubtful findings in urinary cytology. Cystoscopic findings showed that he had an urethral tumor in the prostatic urethra as well as bladder tumor. Both were resected transurethrally. Histological examination revealed that both urethral tumors were papillary adenoma of the prostatic urethra, corresponding to the adenomatous polyps with prostatic type epithelium in the classification of AFIP. The peroxidase-antiperoxidase complex method was performed using the anti-prostatic acid phosphatase antibody and anti-prostatic-specific antigen antibody, and positive reactions were obtained which confirmed that the tumors originated in the prostatic tissue. Benign urethral tumor in males is not common and description of adenomatous polyps with prostatic type epithelium is very rare. We could find only 11 cases in the Japanese literature.

It is well known that serum calcitonin (CT) levels in infantile rats are higher than those in adult rats. In the present experiment, the effects of parathyroidectomy or calcium administration on serum calcitonin levels were observed in suckling rats. Bilateral parathyroidectomy (Px) on 3-, 5-, 7-, 8- or 14-day-old Wistar-Imamichi female rats was performed surgically under a dissecting microscope. Ether anesthesia was used. In the first experiment, the Px rats of various age groups were killed 1 week after the operation. In the second experiment, time course effects of Px on one-week-old rats were observed 1, 2 or 3 weeks after the operation. CT in the serum and thyroid extracts (0.001N HCl) was measured using radioimmunoassay kits for human CT. Serum Ca was measured by the OCPC method and serum inorganic phosphates was measured by the Takahashi method. Serum calcium levels showed a significant decrease 1 week after Px in all age groups. In these rats, serum CT levels showed a slight increase or no changes, and a significant increase in CT concentrations in the thyroid gland was observed in all age groups. Moreover, the increase in CT contents in the thyroid gland became larger 3 weeks after Px in rats operated on at one week of age. Thyroid extract containing 70 pg immunoreactive CT was effective in decreasing 1.22 mg/100 ml serum calcium at 15 min after i.v. injection in a bioassay system in which a dose response curve of human calcitonin was used as standards. Acute s.c. injection of CaCl2 solution resulted in a significant increase in serum CT levels 15 and 30 min later in intact 2- and 3-week-old rats, whereas no significant change in serum CT levels was observed in one-week-old intact rats. Three and 15 min after s.c. injection of Na2EDTA, serum Ca levels decreased markedly, but thyroidal CT contents tended to increase 3 and 5 min after the injection. The results indicated that parathyroidectomy in infantile rats induces a marked increase in biologically active calcitonin in the thyroid gland, inspite of the significant decrease of serum Ca levels.

Effects of azosemide on diuresis, plasma renin activity (PRA), and urinary prostaglandin E (PGE) excretion in normal rats and rats pretreated with indomethacin were studied in comparison with those of furosemide. Azosemide at doses ranging from 10 to 40 mg/kg p.o. dose-dependently increased urinary volume and Na+, K+, and Cl- excretions. In this case, the increases in urinary volume and Na+, K+, and Cl- excretions with 40 mg/kg of this drug were 3.4 and 4.1, 2.9, and 5.8 times, respectively. Pretreatment with indomethacin (10 mg/kg X 3 p.o.), a PG synthesis inhibitor, inhibited the increasing effects of this drug on urinary volume and Na+ and Cl-excretions by 80 or approximately 90%. Moreover, the increasing effects of this drug on PRA and urinary PGE excretion were also inhibited remarkably to the same degree by pretreatment with indomethacin. These effects of azosemide were roughly similar to those of furosemide. From these results, the diuretic action of azosemide, like that of furosemide, may partly be mediated through the activation of the PG system in kidney.

Since 1983, eight cases of adrenal incidentaloma were experienced at the Department of Urology, Wakayama Medical College and affiliated hospitals. Six adrenal masses were incidentally detected by computed tomography, and two were first noted by either ultrasonography or intravenous pyelography. Surgical exploration was performed in all cases as the final diagnostic measure. Of them, three had adrenocortical adenomas, three had adrenal cysts, one had adrenal metastasis and one had pheochromocytoma. Preoperative evaluation revealed that all patients except one with pheochromocytoma had no endocrinological abnormality. The management of the adrenal incidentaloma, which will be discovered more frequently accompanied with the increasing use of computed tomography, was discussed with special references to its precise indication of surgical treatment.

A 49-year-old man was admitted with the suspicion of renal foreign body. A fragment of wire rope was penetrated from his right lumbar region while working. Drip infusion pyelography and computed tomography films revealed a linear metallic object in the region of the right kidney. The foreign body was successfully extracted from the right renal parenchyma. The 38 cases of foreign bodies in the upper urinary tract including 12 in the renal parenchyma found in the literature are reviewed.

The diuretic effect of azosemide in HgCl2-induced acute renal failure of rats was investigated in comparison with that of furosemide. Acute renal failure was induced by the single s.c. injection of 1, 2, or 4 mg/kg HgCl2; and the test drug was administered 48 hr after treatment with HgCl2. Treatment with HgCl2 resulted in a dose related elevation of plasma urea nitrogen and creatinine levels (mg/dl). In rats with 1 mg/kg HgCl2-induced acute renal failure, azosemide at doses ranging from 10 to 40 mg/kg p.o. dose-dependently increased urinary volume (ml/5 hr) and urinary Na+, K+, and Cl- excretions (mEq/5 hr). In this case, azosemide at 40 mg/kg caused a 3.5-fold increase in urinary volume and 4.5-, 2.1, and 4.1-fold increases in urinary Na+, K+, and Cl- excretions, respectively. Although plasma electrolyte levels were little affected by azosemide, plasma urea nitrogen and creatinine levels were significantly elevated by doses of more than 20 mg/kg of this drug. The diuretic effect of azosemide was more markedly reduced in rats with 2 mg/kg HgCl2-induced acute renal failure than in rats with 1 mg/kg HgCl2-induced acute renal failure. In the case of treatment with HgCl2 of 2 mg/kg, the diuretic effect of azosemide at doses ranging from 40-320 mg/kg p.o. was dose-dependent. However, azosemide had no effect on plasma electrolyte, urea nitrogen, and creatinine levels. The diuretic effect of azosemide in rats given 4 mg/kg HgCl2 was more pronouncedly reduced as compared with that in the case of 2 mg/kg HgCl2. In this case, azosemide at 320 mg/kg brought about a 2.6-fold increase in urinary volume and 4.8-, 4.6-, and 3.9-fold increases in urinary Na+, K+, and Cl- excretions, respectively. This drug had no effect on any plasma parameters. The diuretic effect of azosemide was slightly more potent than those of furosemide in the case of acute renal failure induced by 2 and 4 mg/kg HgCl2.

Partial urethrectomy (at least to the bulbous portion) was performed simultaneously in 128 consecutive male patients undergoing radical cystectomy for bladder cancer. Transitional cell carcinoma developed subsequently in the distal urethral remnant in 5 patients (4.0%) followed for 2.6 to 5.7 years (mean 4.1 years) postoperatively. These 5 patients originally had nonpapillary, multifocal and histologically high grade (5) and low stage (4) bladder cancer, 4 with associated carcinoma in situ. Our results suggest that simultaneous total urethrectomy should be considered strongly for patients with high grade nonpapillary multifocal bladder cancer associated with carcinoma in situ. Furthermore, the pattern of distal urethral recurrence in our patients may provide information regarding the appropriate management of the male urethra in potential candidates for continent urinary diversion.