A 62-year-old man was referred for an aortic-valve surgery because of severe aortic stenosis. Thirty years ago, he had undergone a mitral valve commissurotomy and after 9 years, the valve had been replaced by a mechanical valve. He had been undergoing hemodialysis for the past 8 years. A computed tomographic (CT) scan of the chest and abdomen showed a dense circumferential calcification in the wall of the entire thoracic and abdominal aorta, pulmonary artery, and left and right atrium. A conventional aortic-valve replacement was performed. To avoid an embolic event, a "stepwise aortic clamp" procedure was attempted and involved the following: (1) brief circulatory arrest and aortotomy during moderate hypothermia; (2) balloon occlusion at the ascending aorta during low-flow cardiopulmonary bypass (CPB); (3) endoarterectomy by using an ultrasonic surgical aspirator to enable aortic cross-clamping; and (4) a cross-clamp reinforced with felt and full-flow CPB. The patient recovered without any thromboembolic events. Using this procedure to treat a porcelain aorta seemed to reduce the time limit and reduced the risk of brain injury during cardiac surgery.
We evaluated calcium metabolism and bone demineralization by measuring specific markers for bone reabsorption and bone mineral density in patients with an intestinal neobladder.We studied 33 men 55 to 72 years old who underwent creation of an orthotopic sigmoid (23), ileocolic (8) or ascending colon (2) neobladder after cystectomy. Mean followup plus or minus standard deviation (SD) was 28.4+/-30.1 months (range 4 to 114). Serum electrolytes and arterial blood gases were measured. As markers of bone absorption we assayed urinary pyridinoline, deoxypyridinoline and N-terminal pyridinoline cross-linked telopeptides, and serum pyridinoline cross-linked C-terminal telopeptide of type I collagen. Bone mineral density of the spine and femur was determined by dual x-ray absorptiometry.Mean blood pH plus or minus SD was 7.38+/-0.04 (range 7.29 to 7.43). Mean plasma bicarbonate was 22.9+/-3.4 mmol./l. and mean base excess was -1.63+/-3.61 mmol./l. Serum sodium, potassium, calcium, alkaline phosphatase and phosphate were normal in most patients. Mean serum chloride was 108.0+/-3.5 mEq./l., and was elevated in 9 of the 33 patients (27.3%). Serum intact parathyroid hormone was normal in all patients, osteocalcin was increased in 2 and 1alpha, 25-dihydroxyvitamin D3 was decreased in 2. Pyridinoline cross-linked C-terminal telopeptide of type I collagen was higher in 19 of 33 cases (57.6%) and N-terminal pyridinoline cross-linked telopeptides were elevated in 6 (18.2%). Pyridinoline and deoxypyridinoline were higher than normal in 19 (57.6%) and 7 (21.2%) patients, respectively. C-terminal telopeptide of type I collagen and deoxypyridinoline significantly correlated with serum pH (p = 0.017 and 0.0418, respectively). Z score for the bone mineral density of L2 to L4, the femoral neck and Ward's triangle was -0.350+/-1.031, -0.82+/-0.99 and -0.94+/-1.01, respectively.In patients with a neobladder of intestinal segments metabolic acidosis results in increased bone absorption and decreased bone mass. Thus, attention should be given to bone metabolism in patients with even mild acidosis after orthotopic neobladder creation.
(Background) Ectopic production of immunoreactive hCG/hCGβ (IR-hCGβ) by bladder transitional cell carcinoma cell lines was investigated in vitro and in vivo.(Methods) As an in vitro study, IR-hCGβ in culture media from 2 bladder transitional cell carcinoma cell lines (KoTCC-1 and HT-1197) was analyzed by three kinds of enzyme immunoassays (EIA) which were specific for intact hCG, free hCGβ and β-core fragment (β-CF). As an in vivo study, distribution of IR-hCGβ was analyzed in tumor tissues, sera, and urine of the nude mice and the nude rat transplanted with KoTCC-1 cell line.(Results) Both of the cell lines were determined to secrete IR-hCGβ into the media, which consisted principally of free hCGβ. Intact hCG and β-CF were scarecely detected in the media. Immunohistochemical study revealed the localization of IR-hCGβ in transitional cell carcinoma cells of the transplanted tumor. Although a large amount of IR-hCGβ could be detected in both of the serum and urine from the animals, there were quantitative and qualitative differences between serum and urinary IR-hCGβ. Quantitatively, the concentrations of IR-hCGβ in the urine were consistently much higher than those in the serum. Qualitatively, free hCGβ was exclusively detected in the serum whereas a large amount of β-CF, in addition to free hCGβ, were found in the urine. Intact hCG could not be detected in both serum and urine. These distributions of IR-hCGβ in the animals bearing tumors were completely analogous to those in patients with bladder carcinoma.(Conclusion) The present results suggested that ectopic production of IR-hCGβ by bladder carcinoma is not rare phenomenon and it is clinically useful as a tumor marker when β-CF is measured in the urine.
We report a case of bilateral renal cell carcinoma which developed during about 14 years of hemodialysis. The patient of male was a 39-year-old with a chief complaint of macrohematuria 14 years prior to dialysis therapy. Computed tomography revealed multiple cystic changes of bilateral kidneys and a high density area in the right kidney. He was admitted to our department in April 1988. He was suspected of renal cell carcinoma of the right kidney and underwent transperitoneal radical nephrectomy on the right kidney. The left kidney was also resected simultaneously in part because it failed to function and in part because the long-term hemodialyzed patients are considered to have a complication of renal cell carcinoma at a high frequency. Pathological diagnosis was bilateral acquired cystic disease of the kidney (ACDK) with renal cell carcinoma. The kidney develops multiple cystic changes following long-term hemodialysis, which forms a high risk for development of renal cell carcinoma. This is a case of bilateral renal cell carcinoma which occurred after long-term hemodialysis, was reported with discussion and reference to the literature.
Introduction: Septic pulmonary embolism is a rare disease. It occurs when a pathogenâcontaining thrombus embolizes to the lung. We experienced a patient who had deep vein thrombosis due to physical immobility, and sequentially had septic pulmonary embolisms. Computed tomography showed a thrombus in the pulmonary artery and multiple nodules with surrounding blood vessel conversion. We noticed that the patient had periodontitis, and we used phosphomycin, which was quite effective. In conclusion, computed tomography is useful for diagnosing a septic pulmonary embolism. Antibiotics are key drugs in controlling this disease.
A 68-year-old woman was hospitalized complaining of right flank pain. The excretory pyelogram revealed that the right kidney was hydronephrosis, and a retrograde pyelogram showed stringy filling defects in the middle portion of the right ureter. Suspecting a right ureter tumor, a right ureteronephrectomy was performed. The pathological diagnosis was ureteral cholesteatoma which is a rare condition with reports of only 9 cases in the Japanese literature. Although the possibilities of malignant change has been debatable, long term follow up would be mandatory.
The open-style stent graft technique has been changing the strategy for true distal arch aneurysms extending to the descending aorta. Our mid-term results of surgical repair using a J-graft open stent graft are presented.Between May 2015 and June 2020, 69 patients with a distal arch aneurysm (53 males, median age 74 years) underwent total arch replacement combined with J-graft open stent deployment. All 59 surviving patients were followed for a median follow-up period of 1.8 (0.6-3.6) years.Antegrade deployment was successfully performed in all patients without any difficulties. The deployed device was securely fixed at the target area, and it initiated thrombus formation. The diameter of the excluded aneurysm was decreased in 54 patients (91.5%) during the follow-up period. There were no type I endoleaks, but there were 3 type II endoleaks; 2 of the 3 type II endoleaks disappeared during the follow-up period. Additional endovascular operations were performed in 3 patients. There were 10 in-hospital deaths (14.5%), and the incidences of stroke, spinal cord injury and distal embolism were 11.6%, 5.8% and 2.9%, respectively. The 1- and 3-year survival rates were 84.8% and 79.4%, respectively, and the 1- and 3-year freedom from reintervention rates were 97.2% and 81.3%, respectively.The J-graft open stent graft was easy to deploy, and it could shift the distal anastomosis to a more proximal side. The mid-term performance of this device was good. It has the potential to provide one-stage repair.
The clinical significance of serum basic fetoprotein (BFP) in prostatic cancer was investigated together with serum prostatic acid phosphatase (PAP), γ-seminoprotein (γ-Sm) and prostate specific antigen (PA).Investigated in this study were 40 patients with prostatic cancer, ranging in age from 50 to 85 years (mean age: 69.5 years). According to clinical staging, 3 cases (7.5%) had a stage A disease, 10 cases (25.0%) a stage B disease, 7 cases (17.5%) a stage C disease, and 20 cases (50.0%) a stage D disease. The positive rates for serum BFP, PAP, γ-Sm, and PSA were 60.0, 45.0, 63.6, and 68.4%, respectively, and these rates increased as the stage advanced. The above results suggest that BFP is the most useful marker of the four for monitoring prostatic cancer.In a combination assay of these four markers, 29 (87.9%) of 33 patients with prostatic cancer could be diagnosed by observing an elevated serum level in one of the markers. This suggests that a combination assay of BFP, PAP, γ-Sm and PSA in patients with prostatic cancer is useful for diagnosis and monitoring of the disease.
