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ErSiO crystalline compounds such as erbium silicates (Er 2 Si 2 O 7 and Er 2 SiO 5 ) and Er 2 O 3 have been attracting attention as the new light source material for silicon photonics. In our previous reports, several results indicated that the ErSiO crystalline compound was non-stoichiometry (Er:Si:O=1:2:2.4) and showed carrier mediated excitation. In our later study, however, it has been found the ErSiO crystalline compound contains Er 2 SiO 5 (PDF#52-1809) crystalline matrix. ErSiO compounds made from the sol–gel solution of Er:Si=1:2 and Er:Si=2:1 show that the X-ray diffraction (XRD) peak patterns are in good agreement with the Er 2 SiO 5 . Rutherford back scattering (RBS) and secondary ion mass spectrometry (SIMS) results for the ErSiO compounds also show phase separation of Er 2 SiO 5 and SiO 2 . SiO 2 -rich Er 2 O 3 –SiO 2 systems usually show phase separation of Er 2 Si 2 O 7 and SiO 2 but this system behaves in a different manner. Furthermore, bulk Er 2 SiO 5 emits light only by direct excitation of Er. From PL excitation (PLE) measurements, the indirect excitation emission observed in the Si-rich non-stoichiometric ErSiO compound is considered due to Er 2 SiO 5 crystallites embedded in SiO x , which can be formed by the phase separation.

Carrier spin relaxation in undoped GaAs/AlGaAs asymmetric double quantum wells (QWs) at room temperature was studied by spin-dependent pump and probe reflection measurements. The electron tunneling, which occurs between the two lowest conduction bands in the narrow and wide QWs, has a negligible effect on the electron spin relaxation. The most striking feature is that a long hole spin relaxation time was directly observed in the case of fast electron tunneling while it was not observed in the case of relatively slow electron tunneling. The hole that remains in the QWs due to the escape of the electron tunneling out makes the direct observation of hole spin relaxation possible. The measured hole spin relaxation time varies from 107 ps to 80 ps when the excitation power changes from 10 mW to 40 mW. This study provides direct experimental evidence of the important effect of the interaction between electrons and holes on the hole spin relaxation. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Nonresonant carrier tunneling dynamics in GaAs/AlGaAs double quantum wells as a function of carrier density was investigated by using time-resolved pump and probe measurements. At low temperatures, tunneling time increases with increasing carrier density. At high temperatures, no dependence of tunneling time on carrier density was shown. This unique behavior is well explained by the thermodynamic effect be- tween excitons and free carriers as a function of carrier density on the tunneling process. At low temperatures, a larger fraction of excitons at a higher carrier density, which have a relatively slow tunneling time in contrast to free electrons, leads to a slow tunneling time. The independence of the tunneling time at high temperatures is attributed to the insensitivity of the exciton population to the increased carrier density. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

ErSiO superiattice crystal (SC) wavegaide is demonstrated. ErSiO-SC film was formed on a SiO 2 /Si substrate. After the ErSiO preform formation by sol-gel method, high temperature anneal for the crystallization was performed in Ar atmosphere. Then the ErSiO-SC layer thickness is 220 nm. Then refractive index of ErSiO-SC was estimated to be 1.8 by ellipsometry and reflection spectroscopy measurements. To obtain the lateral optical confinement, polymer cladding layer (n=1.54) was conted on the ErSiO-SC film and the striploaded structures with 5 μm width were formed by focused ion beam (FIB) etching. The optical confinement factor Γ of the ErSiO-SC waveguide layer was estimated to be 0.42, assuming the lateral confinement factor was 1 because of the sufficient wide waveguide for the light. Optical pumping was performed by using a 1480 nm laser diode through the lensed fiber. The pumping power is 30 mW at the fiber input. Green light emissions corresponding to 4f intra-shell transitions from 4 S 3/2 and 2 H 11/2 to 4 I 15/2 in the Er 3+ ions, indicating cooperative upconversion in the ErSiO-SC waveguide, can be observed by using a conventional CCD system at room temperature. The upconversion emission behaviour through the waveguide with a photon trap for the 1480 nm light reveals that the 1480 nm pumping light is well-confined into the waveguide. The cooperative upconversion as the gain limitting factor in the ErSio-SC waveguide are discussed.

Nonresonant carrier tunneling has been studied as a function of temperature in GaAs/AlGaAs double quantum wells (DQWs). Time-resolved pump and probe reflectance measurements allow the direct observation of tunneling at any temperature between 15 K and room temperature. We found that for two DQWs with different barrier thicknesses, the tunneling time abruptly decreases above a critical temperature while it remains almost constant below the critical temperature. This critical temperature is shown to correspond to the exciton binding energy. Rate equation analysis explains this behavior as the thermalization of excitons into free electrons that have a faster tunneling time than excitons.

Analysis of answers to a new questionnaire.To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan.Nationwide questionnaire survey to physicians in Japan.A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS).We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping.This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.

The energy relaxation time of hot carriers photoexcited in bulk InGaN is measured. The time-resolved pump and probe transmission measurements with subpicosecond time resolution show that the hot-carrier relaxation time is 0.92 ps at 15 K. The hot-carrier relaxation time becomes significantly shorter at higher temperatures. At temperatures higher than 150 K, there are no meaningful differences between rise times. This strong temperature dependence indicates that electron-phonon scattering dominates the carrier relaxation process. (© 2008 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

We report a case of severe mitral regurgitation due to partial rupture of an anterior papillary muscle. A 63-year-old man was admitted to a hospital with heart failure. He was treated with diuretic agents effectively. Echocardiography demonstrated severe mitral regurgitation with prolapse of posterior leaflet and small mass-like structure on the prolapsed segment that was diagnosed the thickened leaflet. Coronary angiography revealed total occlusion of left anterior descending artery (LAD) filled with good collateral from right posterior descending artery and severe diffuse stenosis of circumflex artery (Cx). The patient underwent surgery on the 33rd day after admission with heart failure. At surgery, we recognized rupture of one of the heads of anterior papillary muscle that was entangled in chordae of the prolapsed segment. Mitral valve repair and coronary revascularization to LAD and Cx was successfully performed. His postoperative course was uneventful, and he was discharged on the 28th postoperative day.

The spin relaxation process of acceptor-bound excitons in wurtzite GaN is observed by spin-dependent pump and probe reflectance measurement with subpicosecond time resolution. The time evolutions measured at 15–50K have a single exponential component corresponding to the electron spin relaxation time of 1.40–1.14ps. The spin relaxation time is found to be proportional to T−0.175, where T is the temperature. This weak temperature dependence indicates that the main spin relaxation mechanism is the Bir-Aronov-Pikus process [Sov. Phys. JETP 42, 705 (1976)].

ErSiO superlattice crystal waveguide is demonstrated. Due to the optical confinement effect, upconversion emission can be observed. From the upconversion, the light propagation properties in the waveguide are discussed

A method is proposed for correction of false colour in scanned images. The false colours were detected by inspecting the permutation of R, G and B edges in the high contrast portions in the image. The corrections were performed by replacing the portions with false colour by the intensity profile, which is the piece wise linear fitting to the profile of the portion to be corrected. The results show that the present method is effective both to the monochrome and colour images, but the corrections are "under correction".

Amplitude notches in the transmission band are selected as the measure for instantaneous evaluation of transmission deterioration through multipath propagation characteristics since they can accommodate conventional macrostatistical processing. Notch analyses of various propagation models are performed, and notches generated by a recently developed multipath generator are measured. The results obtained by calculations and measurements are compared. These comparisons confirm that notch analysis is effective as a means of evaluation of propagation paths.

A novel lateral MIM-LCD, (liquid crystal display) has been developed which has a high pixel density (about 270 dpi) and a high contrast ratio over a wide temperature range (over 130:1 from 0 degrees C-80 degrees C). Two types of lateral MIM-LCD are presented: a 4.2-in-diagonal, 640-pixel*240-pixel LCD with each pixel addressed by eight parallel-lateral-MIMs and a 2.98-in-diagonal 640-pixel*480 pixel LCD with each pixel addressed by back-to-back lateral MIM. This lateral MIM can be used for an electric view finder or a light valve because the pixel-size can be designed to be sufficiently small and can attain high aperture ratio. In addition, the redundancy of pixel defects can create high yield ratio when fabricating displays such as the full color workstation display. >

We evaluated the clinical usefulness of individualized chemotherapy based on an in vitro chemosensitivity test, i.e., the histoculture drug response assay (HDRA), for urothelial cancer.62 clinically obtained cancer specimens were studied. Each specimen was tested for sensitivity to nine anticancer drugs. The antitumor effect was calculated as the inhibition rate to their control values. The HDRA effective cytotoxic drugs were selected for clinical treatment.HDRA was possible in 58 out of 62 specimens (93.5%). Their chemosensitivity showed a wide variety even among the same histological category. No correlation was seen between histological grade and chemosensitivity. The effect of chemotherapy on the measurable lesions was studied in 12 patients and good clinical responses were obtained in 7 of them (58.3%). All 7 responders were the patients who received drugs predicted to be effective by HDRA. In 8 out of the 12 patients (66.7%), including 7 true-positive and 1 true-negative, HDRA correctly predlicted the clinical effect of chemotherapy.The HDRA might be feasible for predicting the efficacy and, therefore, selecting the proper anticancer drug for individual patients.

A 72-year-old man was diagnosed with hypertension, hypokalemia, and left adrenal tumor at another hospital, and was referred to our hospital on suspicion of primary aldosteronism. Investigations revealed low plasma aldosterone concentration, and the left adrenal tumor proved to be nonfunctioning, not hyperfunctioning. "Licorice" had been prescribed for the treatment of recurrent cramps in his calf. After stopping the licorice, his condition changed to normokalemia strongly suggesting that his pseudoaldosteronism had been caused by the drug. We reviewed 140 reports on licorice-induced pseudoaldosteronism in Japan, and found a second patient who might have suffered a similar coincidental nonfunctioning adrenal tumor.

An 18-yr-old man received a kidney graft from a 60-yr-old female cadaver donor on February 8, 1996. Postoperative course was uneventful and his serum creatinine level was stable at about 1.8 mg/dL. On April 30, 1999, he collided with a truck while riding a motor cycle. Macroscopic hematuria was observed and CT showed an extensive retroperitoneal hematoma. Because his anemia and hypotension were becoming worse after transfusion of 9 units of blood, he was operated on as an emergency case. A large rupture reaching the pelvis and calyces was observed in the upper pole of the grafted kidney. There were also numerous shallow lacerations, but the major arteries and veins were not injured. The rupture was closed by suturing the renal parenchyma with the peritoneum, and the other shallow lacerations were closed by suturing the renal capsule. The kidney could be salvaged without requiring hemodialysis. The serum creatinine was maintained at 2.1 mg/dL during follow-up. A review of the literature showed that 6 cases of traumatic renal graft rupture with salvage of the kidney have been reported. Our present case was the seventh, and was the most severe graft rupture reported so far.

Study design: A retrospective study. Objectives: To investigate the risk factors of vesicoureteral reflux in the early stage of spinal cord injury. Setting: Japan. Methods: Urological evaluation, including cystography and urodynamic study was performed in patients in the early stage of spinal cord injury. The patients were divided into two groups. Group 1 included 13 patients with vesicoureteral reflux. Group 2 included 97 patients without vesicoureteral reflux. We compared Group 1 and Group 2 regarding bladder deformation, the level of spinal cord injury, bladder behaviour, bladder compliance, high urethral closure pressure and method of urine evacuation. Results: The patients injured between Th10 and L2 showed a significantly higher incidence of vesicoureteral reflux than those injured in other areas (P

Thymidine phosphorylase (TdR-Pase) is an essential enzyme for the metabolism of fluorouracil-related drugs and it is also recognized as a potent angiogenic factor. We measured the TdR-Pase activity in human transitional cell cancers (TCCs) of the urinary tract to assess the relationship between TdR-Pase activity and degree of tumor malignancy. Furthermore, we investigated the relationship between TdR-Pase activity and chemosensitivity to fluorouracil-related drugs.Sixty-two TCC tissues and 12 normal bladder tissues were obtained. TdR-Pase activity was measured with the enzyme-linked immunosorbent assay. The in vitro histoculture drug response assay was also performed to investigate tumor sensitivity to 5-fluorouracil (5-FU) and doxifluridine (5'-DFUR).The TdR-Pase activity of TCCs was three-fold higher than that of normal tissues. The TdR-Pase activity increased along with the histological grade, and the TdR-Pase activity of invasive cancers was significantly higher than that of superficial cancers. However, TdR-Pase showed no relationship with the sensitivity to 5-FU or 5'DFUR.A high TdR-Pase activity in human TCCs was confirmed to predict a high tumor grade and stage. However, the anti-tumor effect of fluorouracil-related drugs was independent of the TdR-Pase activity.

A 29-year-old man was referred to our hospital with loss of appetite and a left lower abdominal mass. A small nodule was palpable in his left testis and ultrasonographic examination demonstrated that the nodule was low echoic. Computed tomography showed a large mass in his left retroperitoneal space. We thought the mass was a metastatic lesion from a testicular tumor. Left orchiectomy was done and microscopic examination revealed no viable tumor cells. Only fibrous tissue, small calcified areas, and hyaline bodies were found. As tumor markers were normalized after 3 courses of chemotherapy with bleomycin, etoposide, and cisplatine, the retroperitoneal mass was removed with the left kidney. It consisted of embryonal carcinoma, mature teratoma, and yolk sac tumor. One course of adjuvant chemotherapy was done and the patient has since been free from recurrence. We suppose that the tumor was a so-called 'burned-out' testicular tumor.

In view of the importance of estrogen and IL-6 in the pathogenesis of rheumatoid arthritis (RA), the effects of 17 beta-estradiol (E2) on interleukin (IL)-6 production in cultured rheumatoid fibroblast-like synoviocytes were investigated.Cultured fibroblast-like synoviocytes obtained from RA joints were treated with the vehicle (control), as well as 10(-8) and 10(-6) M of E2, with or without IL-1 beta stimulation. After 72 hours of culture, the levels of IL-6 in supernatants were measured by ELISA.Treatment with 10(-8) and 10(-6) M of E2 had no effect on the constitutive production of IL-6 in cultured fibroblast-like synoviocytes. However, E2 increased IL-1 beta-induced IL-6 production in a dose-dependent manner, with a mean 12.5% increase with 10(-8) M of E2 (p = 0.048) and 33.4% with 10(-6) M (p0.0001) versus the control.Estrogen up-regulates IL-1 beta-induced IL-6 production in cultured fibroblast-like synoviocytes, possibly contributing to the enhancement of rheumatoid inflammation in synovial tissues.

Penile metastasis is rare. It occurs in the advanced stage of genitourinary cancer, with many other metastases in various organs. All 7 patients with penile metastasis of renal cell cancer, reported in the Japanese literature, died within a year. Our case was not the exception. A 69-year-old male presented with right flank pain and penile induration. Right renal cancer with liver invasion and multiple pulmonary metastases were found. Microscopic examination revealed a sarcomatous pattern. He died 4 months later.

A case of renal malignant lymphoma is reported. A 74-year-old man was admitted to our hospital on September 8, 1995, complainning of right flank pain, abdominal mass, and anorexia for two months. Physical examination revealed an enlarged right axillary lymph node and abdominal mass of child's head size. Computerized tomography showed a tumor (11 x 7 cm) encompassing the right kidney parenchym, and enlarged paraaprtoc lymph nodes with invasion of the left iliac creat. Transcutaneous echo-guided needle biopsy revealed that the tumor was non-Hodgkin's malignant lymphoma, diffuse large cell type, positive for B cell marker. The patient was treated with full dose of CHOP regimen. However, adriamycin was replaced with pirarubicin and the dose of the other drugs were reduced for the subsequent 4 courses because of severe leukocytopenia, thrombocytopenia, hepatotoxicity, and alopecia after the first course of the treatment. The patient showed complete remission and discharged on March 12, 1996. He, after 17 months, has no signs of recurrence. We reviewed 43 Japanese cases previously reported as renal malignant lymphoma. It is increasing in Japan especially in elderly. The 2-year survival is 26.6%.

Radiological examination is essential in diagnosing osteoarthritis (OA) of the knee. However, diagnoses that are not based on radiological examination are preferred in epidemiological studies, and the American College of Rheumatology (ACR) has recommended classification criteria for OA of the knee based on clinical examination, and indicated that these classification criteria were appropriate for epidemiological studies. To evaluate the validity of this criteria, we examined the interobserver reproducibility as well as the sensitivity and specificity of the criteria for outpatient attenders complaining knee pain with wide spectrum of rheumatic diseases. As a result, interobserver reproducibility was considered good, but both sensitivity and specificity were slightly lower than the report by ACR in which representative rheumatic diseases such as rheumatoid arthritis were chosen as control. We therefore consider that ACR classification criteria for OA of the knee in of value, but that radiological examination should be preferred in case it is possible.

Generalized osteoarthritis (OA) is a common disease, more often affecting women than men. Although genetic factors are known to be the major risk factor, the genes related to its development are as yet undetermined. We investigated the association between estrogen receptor gene polymorphisms and generalized OA.Pvu II and Xba I restriction fragment length polymorphisms (RFLP) of estrogen receptor gene were analyzed in 65 Japanese patients with generalized OA and in 318 healthy control women. The RFLP were represented as Pp(Pvu II) and Xx(Xba I), with capital and small letters signifying the absence and the presence of restriction sites, respectively.Estrogen receptor genotype PpXx, with the combination of the Pvu II and Xba I RFLP, is a significant risk factor for the disease subset (odds ratio 1.86, 95% confidence interval 1.03-3.24; p = 0.039). The association of this genotype was more obvious in patients with severe radiographic changes and in younger patients.Some variant of the estrogen receptor gene is a genetic marker for generalized OA. How this genotype affects development of the disease remains to be elucidated.

A 40-year old woman had experienced repeated spontaneous pneumothorax on the right side at the beginning of each menstrual period for one year. The level of serum CA125 was high at 60 ng/ml. Right thoracotomy revealed the presence of multiple darkly-pigmented spots and several pinhole like perforations near the central tendon of the diaphragm. The partial resection of the diaphragm was done, endometrial tissues were detected histologically. Tha patient has been asymptomatic after operation and the level of serum CA125 is normal.

A 40-year-old female, whose blood type was A, Rh+, was admitted to our hospital for kidney transplantation from her younger brother whose blood type was B, Rh+. Before the transplantation, we performed 4 sessions of double filtration plasmapheresis (DFPP) to remove the anti-B antibodies. The serum anti-B antibody titer lowered from X32 to X4. The kidney transplantation was carried out following the splenectomy. The warm ischemic time was 8 minutes and the cold ischemic time was 47 minutes. Five immuno-suppressive agents including cyclospolin, azathioprine, prednisolone, anti-lymphocyte globulin (ALG), and deoxyspergualin were administered in the initial period. Nine days after the transplantation, an acute rejection occurred, and 15 sessions of hemodialysis were needed. However, Methylprednisolone and OKT3 treatment resulted in recovery of the graft function. Seventy-four days after the transplantation, she was discharged with the serum creatinine concentration of 1.3 mg/dl. The DFPP before transplantation was useful to remove the anti-RBC antibody from the patient receiving an ABO incompatible kidney allograft.

In order to evaluate the utility of laparoscopic adrenalectomy for Cushing's syndrome, the results of 6 laparoscopic adrenalectomies for Cushing's syndrome were compared with those of 34 other laparoscopic adrenalectomies, consisting of 7 pre-Cushing's syndromes, 13 primary aldosteronisms, and 14 non-functioning adrenal tumors. The results were also compared with 5 open adrenalectomies for Cushing's syndrome. The results of the laparoscopic adrenalectomies for Cushing's syndrome were as follows: the mean operating time was 216 +/- 46 min, and the mean estimated blood loss was 180 +/- 194 ml. From the third patient, an ultrasonic surgical system was used and the estimated blood loss decreased significantly. The ultrasonic surgical system, together with a more experienced surgical technique, also cut down the operating times. During surgical intervention, 2 complications occurred; a hemorrhage of more than 500 ml in one patient, and splenic injury in another, which was treated by compression. Postoperative complications occurred in 2 patients; paralytic ileus in one, and abdominal pain due to the pneumoperitoneum in the other. All patients except 2 patients with vertebral fracture began oral intake and ambulation 1 to 4 days postoperatively, and resumed normal daily activity on postoperative day 5 to 7. Compared with the laparoscopic adrenalectomies for the other adrenal tumors, the operating time and estimated blood loss in the Cushing's syndrome patients was not substantially different, though postoperative recovery was slightly longer. When compared with the open adrenalectomies, the operating time was longer, but the postoperative recovery period was significantly shorter. We conclude that with careful surgical intervention, experience of technique, and the introduction of proper equipment, a laparoscopic adrenalectomy for Cushing's syndrome can be performed as less-invasively as a laparoscopic adrenalectomy is for the other adrenal tumors. Furthermore, our findings suggest that laparoscopic adrenalectomy for Cushing's syndrome is likelier to have better postoperative results than conventional procedures, including a more rapid recovery to normal daily activity.

(PURPOSE). To determine the efficacy of extraperitoneal laparoscopic adrenalectomy for patients with adrenal tumor, the clinical results of 9 patients treated with this procedure were analysed. (PATIENT AND METHOD). Between July 1994 and March 1995, we have performed extraperitoneal laparoscopic adrenalectomy using the modified Gaur technique of balloon dilatation of the retroperitoneum in 4 men and 5 women with unilaterla small adrenal tumor who were 30 to 79 years old (mean age 56 years). Preoperative diagnosis was primary aldosteronism in 2, 18-hydroxycorticosterone producing adnoma in 1, pre-Cushing syndrome in 5, and nonfunctioning adrenal tumor in 1 patient. The operations were performed with the patients on lateral position and 4 torocars were positioned. The retroperitoneal space was first dissected bluntly by the index finger and a balloon dissector through a small skin incision, and the retroperitoneal space was insufflated with carbon dioxide at the pressure of 10 to 12 mmHg. After the dissection of the adrenal gland, adrenal vein was clipped and transected. The completely freed adrenal gland was enclosed in an entrapment sack and removed en bloc through the open laparoscopy wound. (RESULTS). All 9 procedures were successfully performed. The mean estimated blood loss and the mean operating time were 53 ml and 168 min respectively. There was no intraoperative complication. A postoperative retroperitoneal hematoma was observed in one patient, however it spontaneously resolved without surgical management. (CONCLUSION). In open adrenalectomy, the benefit of the extraperitoneal approach (excluding patients with pheochromocytoma or bilateral lesions) have already been established elsewhere. Although the working space is smaller than that of peritoneal approach, and the surgical techniques are slightly more difficult, extraperitoneal laparoscopic adrenalectomy promises to be safe and a minimally invasive treatment for patients with unilateral small adrenal tumors except for pheochromocytoma.

Fifty patients with adrenal tumors (18 men and 32 women, average age 51.8 years) underwent laparoscopic adrenalectomy from February 1992 to October 1995. Clinical diagnosis included pheochromocytoma in 3 patients, primary aldosteronism (including 1 with a 11-OH-corticosterone-producing tumor) in 15, Cushing's syndrome (including 7 with pre-Cushing's syndrome) in 13, non-functioning tumors in 17, 1 metastatic adrenal carcinoma, and 1 adrenal tuberculosis. Transperitoneal laparoscopic adrenalectomy was performed by the method reported previously. Extraperitoneal laparoscopic adrenalectomy was performed with the patient under general anesthesia in the lateral position. A working space was created by inserting a balloon dissector through a small skin incision. A total of four trocars were inserted. Three of the 50 patients were switched to open surgery, including 1 with metastatic adrenal carcinoma and 1 with adrenal tuberculosis. Laparoscopic tumor removal was successful in the other 47 patients. The average operating time and blood loss were 209 min and 177 ml, respectively. Blood loss was greater in the patients with pheochromocytoma. In patients with Cushing's syndrome, postoperative recovery tended to take longer. Postoperative complications occurred in 40% of the patients in this group, but all complications were minor and successfully treated without any surgical procedures. In the 10 patients undergoing retroperitoneal laparoscopic adrenalectomy, operative courses were excellent, excluding 1 patient with adrenal tuberculosis. Although laparoscopic adrenalectomy is considered to be appropriate for patients with pheochromocytoma and Cushing's syndrome, it appears unsuitable for the removal of malignant and inflammatory lesions.

Between February 1994 and February 1995, we performed retroperitoneal laparoscopic pelvic lymphadenectomy on 7 patients with prostate cancer between 63 and 76 years old, consisting of 6 patients with clinical stage B2, and 1 patient with stage C. Retroperitoneal laparoscopic procedures were performed under general anesthesia. First, the prevesical space was separated by a balloon dissector to create the working space. Then, three trocars were inserted into the retroperitoneal space at the lower abdominal midline. Except for the first patient, only two surgeons were needed to dissect the obturator lymph nodes, under 5 mmHg CO2 insufflation. The mean operating time was 133 minutes for bilateral lymphadenectomy. The mean number of removed lymph nodes was 4.8 on the left side and 4.2 on the right side. The estimated blood loss ranged from 10 to 66 ml. As none of the patients showed node involvement on the microscopic examination of the frozen section, they immediately underwent total prostatectomy. Additionally removed lymph nodes were 0.8 on the left side and 1.5 on the right side. As for intraoperative complications, endotidal CO2 was elevated in the first patient, but the other patients had no complications. Retroperitoneal laparoscopic pelvic lymphadenectomy is a safe and useful procedure, and may facilitate a lymphadenectomy better than a peritoneal procedure.

A woman successfully delivered two children after cadaveric kidney transplantation. She received a kidney graft at the age of 18 years because of end-stage renal failure due to chronic glomerulonephritis. Eighteen months after surgery, she became pregnant. As she was receiving immunosuppressive therapy with cyclosporin, azathioprine, mizoribine and prednisolone, we discontinued mizoribine. The child was delivered by a caesarean section in week 30 of gestation. Both the increase of liver enzymes and the decrease of creatinine clearance were slight and transient. She successfully delivered another child just a few days before the 4th anniversary of her kidney transplantation. Including this patient, we have experienced 11 deliveries by women bearing kidney grafts. Intensive joint management with the obstetric service is necessary to achieve successful delivery without losing the graft.

A 60-year-old man visited our hospital because of a painless swelling of the left scrotal content which enlarged gradually for these five years. He had no history of trauma at the perineum. Tumor markers such as HCG, AFP and CEA were within normal limits. Left high orchiectomy was carried out after the admission under the diagnosis of suspicious testicular cancer. The resected mass, 16.5 x 12.5 x 9.5 cm in diameter and 900 g in weight, was encapsulated within the tunica vaginalis by a fibrous membrane and contained about 300 ml of reddish black liquid. The normally-appearing left testis was located separately from the mass. Microscopic examination revealed depositions of cholesterine crista in the wall, which are characteristic for a chronic hematocele.

We report a case of prostate cancer showing a complete remission after LH-RH agonist neoadjuvant therapy. A 69-year-old man was referred to our department complaining of pain on urination and urge incontinence. The serum prostate specific antigen (PSA) level was 41.6 ng/ml. Needle biopsy specimens from both lobes revealed moderately differentiated adenocarcinoma. Chest X-ray, computed tomographic (CT) scan, and bone scintigraphy demonstrated neither distant metastasis nor local invasion. LH-RH agonist was administered on a monthly basis as neoadjuvant therapy. After 4 injections, pelvic lymph node dissection and radical prostatectomy were performed on January 11, 1993. Thorough examination did not reveal any cancer cells in the removed specimen. The patient was discharged 30 days after the operation and has shown no evidence of distant metastasis or local recurrence as long as 19 months later.

Living renal transplantation (Tx) was carried out on a 41-year-old male undergoing hemodialysis for a six-month period because of end-stage renal failure due to chronic glomerulonephritis. Tacrolimus (FK 506) was used as one of immunosuppressants. The graft worked immediately after Tx. However, his blood sugar level rose extremely high and use of insulin (IS) was required. At the second postoperative day, 0.3 mg/kg/day of FK506 was administered and the trough level (TL) was as high as 65 ng/ml. The serum IS level decreased from the pre-Tx value of 22 microU/ml to 12 microU/ml. With decrease in the dose of FK506, the TL was normalized, and the dose of IS could be decreased. FK506 has been reported to inhibit IS secretion. Therefore, we must be careful to evaluate the blood glucose level in the use of FK506 for patients with poor glucose tolerance.

A 39-year-old male presented with gross hematuria and left lower abdominal discomfort. Excretory urography showed a left ureteral stone and hydronephrosis. CT scans and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. Angiography revealed a hypervascular lesion at this area. The laboratory data showed a slightly decreased serum potassium level. In the endocrinological study, the serum deoxycorticosterone (DOC) level was markedly elevated. There was, however, no evidence of hypertension. The operation was performed on November 13, 1992. The tumor was almost separated from the left kidney, but an aberrant artery which divided from the renal artery and penetrated the renal parenchyma was found. Therefore, we had to carry out en bloc removal of the tumor together with the left kidney and the ureter which contained the ureteral stone. Pathological diagnosis was adrenocortical carcinoma. After the operation, hypokalemia and the serum concentration of DOC returned to normal range. Therefore, the tumor was diagnosed as DOC producing adrenocortical carcinoma. The patient was discharged 30 days after the operation with uneventful postoperative course. He received 2.5 g of op'-DDD a day. There was no evidence of distant metastasis or local recurrence 12 months after the operation. Nineteen cases of DOC producing adrenocortical tumor have been reported in the world literature. A case and a review of the literature are herein reported.

We investigated the expression of estrogen receptors (ER) and the presence of estradiol in human synovial tissues from subjects without arthritis and patients with traumatic arthritis, osteoarthritis, and rheumatoid arthritis.Synovial tissues were immunostained using ER-D5 monoclonal antibody (Mab) directed toward an ER related protein (p29), ER-ICA Mab directed toward nuclear ER, and antiestradiol serum. Fluorescent estradiol was used to demonstrate specific estradiol binding to ER.(1) p29 was present predominantly in hyperplastic synovial lining cells and smooth muscles of blood vessels. (2) Exogenous estradiol bound to synoviocytes and sublining macrophage-like cells in the inflamed synovium. (3) Endogenous estradiol was also detected in hyperplastic lining cells and macrophage-like cells in arthritic synovium.Our study demonstrated the expression of ER in arthritic synovium and suggested that estrogen modulates local inflammation in various joint diseases via synoviocytes as well as sublining macrophage-like cells.

Since 1977, we have operated on 18 nonfunctioning adrenal tumors. The pathological diagnosis included seven adrenocortical adenomas, three adrenocortical hypeplasias, three ganglioneuromas two adrenal cysts, two myelolipomas and one metastatic cancer. We successfully performed laparoscopic adrenalectomy in 11 of these patients and open surgery in the other 7 patients. In the patients undergoing laparoscopic adrenalectomy, post-operative recovery (fist oral intake, first ambulation, and total convalescence) was remarkably rapid. The indication of adrenalectomy for nonfunctioning adrenal tumors is controversial, but we can not exclude the possibility of malignancy even in small tumors. Therefore, because of the minimally invasive nature of laparoscopic surgery, the indications for operating on nonfunctioning adrenal tumors will be widened by introducing laparoscopic adrenalectomy.

New process to compose a reacted Nb3Sn superconducting cable with aluminum-alloys has been developed by using friction stir welding (FSW) technique. The FSW joining process, which takes place in the solid phase below the melting point of the materials, has considerable advantages such as a high strength of welding zone and much lower distortion due to both small heat affects and reliable control of joining depth as compared with conventional welding method. In order to realize practical aluminum-alloy jacketed Nb3Sn superconductors, we have carried out elemental researches by using FSW technique. For a fabrication of aluminum-alloy jacketed Nb3Sn superconductor of a dimension 17 mmw × 4.9 mmt a Rutherford type superconducting cable having 18 reacted Nb3Sn strands of diameter 1.0 mm was assembled into a set of channel and fitting-cover made of aluminum-alloy A6061-T6 with filling material indium. Then, their joining parts were connected by using the FSW technique. The measurement on critical current (Ic) of the fabricated Nb3Sn superconductor achieved over 9.5 kA at 8 T, 4.26 K even after bending with a radius of 150 mm in a flatwise direction, which showed no degradation in comparison with Ic values multiplied by number of strands in the cable. As the results, we succeeded in developing novel type of aluminum-alloy jacketed Nb3Sn superconductors manufactured by FSW technique, which have large current capacity, sufficient allowable bending strains for a coil winding and improved contact between a cable and an aluminum-alloy jacket. The developed superconductors will be applicable to react-and-wind superconducting magnets having very large current at high magnetic field such as nuclear fusion reactors and detectors for high energy physics of the next generation.