Presence of Turner stigmata in a case of dysgenetic male pseudohermaphroditism with 45,X/46,X+mar karyotype.

A case is reported of dysgenetic male pseudohermaphroditism (DMPH) having Turner stigmata and 45,X/46,X+mar karyotype. The marker chromosome of this patient consisted of most if not all of the short arm, including the sex determining region of the Y chromosome. Although this karyotype is relatively common in Turner's syndrome and occasionally observed in mixed gonadal dysgenesis, DMPH is usually exemplified by a 46,XY karyotype except for one patient reported with 45,X/46,XY mosaicism.

Case report: portal-systemic encephalopathy due to a congenital extrahepatic portosystemic shunt.

We present a case of portal-systemic encephalopathy due to a congenital splenorenal shunt. A 69 year old woman was admitted to hospital because of recurrent episodes of disturbed consciousness. The present episode had begun 3 months prior to admission.

A malignant granular cell tumor of the stomach: report of a case.

We report herein what to our knowledge is the first documented case of a malignant granular cell tumor of the stomach. A 64-year-old woman was admitted to our hospital for investigation of gastric submucosal tumor. Endoscopy disclosed a large hemispherical mass located on the lesser curvature at the gastric antrum with a normal mucosal surface, and computed tomography (CT) revealed a solid tumor about 7 cm in diameter with clear margins.

The first case of insulin-dependent diabetes mellitus with prominent spurious hyperglucagonemia due to interference of immunoglobulin G in glucagon radioimmunoassay (OAL-123) system.

A 51-year-old male was admitted to our hospital because of diabetic ketoacidosis. His symptoms were promptly improved with intensive insulin therapy, but his plasma glucagon immunoreactivity measured by the OAL-123 radioimmunoassay (RIA) system showed persistently high values (3,090-3,210 pg/ml). A computed tomographic scan, abdominal angiography and endoscopic examination of his gastrointestinal tract showed no evidence of glucagonoma.

Central hypothyroidism resulting from pituitary suppression and peripheral thyrotoxicosis in a premature infant born to a mother with Graves disease.

We observed the sequential changes in serum thyroid hormones and thyroid-stimulating hormone receptor antibodies in an infant born at 30 weeks of gestation to a mother with florid Graves disease. Transient central hypothyroidism caused by pituitary suppression was observed after the resolution of peripheral thyrotoxicosis induced by thyroid-stimulating antibody. Central hypothyroidism became overt when the suppression of the pituitary gland after fetal thyrotoxicosis was combined with weak activity of thyroid-stimulating antibody after birth.

[Renal arterial disease-induced tubulo-interstitial lesions].

Renal arterial disease-induced tubulo-interstitial lesions described in this chapter include benign arterio- and/or arteriolo-sclerotic and malignant nephrosclerosis, renal infarction and renal cortical necrosis. In these conditions renal glomeruli as well as tubules are always involved, and consequent loss of nephrons, or renal parenchyma results in interstitial fibrotic changes. The parenchymal lesions have a spectrum from slowly progressive atrophy and loss to necrosis of abrupt onset and disappearance of glomeruli and tubules.

[A case of miliary tuberculosis with high-grade fever that remitted without antituberculosis therapy].

A 23-year-old man was admitted with a persistent high-grade fever of 20 days duration. Chest roentgenogram showed diffuse miliary shadows in both lung fields, highly suggestive of miliary tuberculosis. Sputum, gastric juice, and bronchoalveolar lavage fluid did not, however, reveal acid-fast bacilli on smears.

The effects on blood flows of coronary artery by-pass grafts during intra-aortic balloon pumping.

The internal thoracic artery (ITA), as well as aorto-coronary by-pass grafts, has been used for widely coronary artery by-pass grafting. Intra-aortic balloon pumping (IABP) is the first choice for left ventricular support when low output syndrome occurs during coronary artery by-pass surgery. However, the effect of diastolic augmentation by IABP may vary to the type of grafts.

Aberrant hepatic duct connected with the main pancreatic duct by anomalous pancreato-biliary ductal union: case report.

An aberrant hepatic duct directly connected to the main pancreatic duct with anomalous arrangement of the pancreato-biliary ductal system is reported here, the first report of such a case, to our knowledge. A 53-year-old woman was admitted to our hospital because of cholecystolithiasis with abdominal pain in the right upper quadrant. Endoscopic retrograde cholangiopancreatography (ERCP) showed that an aberrant hepatic duct, which independently drained the right posterior segment of the liver, connected to the main pancreatic duct at a high insertion site distal to the sphincter area of the major papilla.

[Coincident renal cell carcinoma and renal angiomyolipoma in tuberous sclerosis: a case report].

The coincidence of renal cell carcinoma and renal angiomyolipoma in tuberous sclerosis is extremely rare, although the coexistence of tuberous sclerosis and renal angiomyolipoma is well recognized. A case of bilateral renal angiomyolipomas and left renal cell carcinoma in a patient with tuberous sclerosis is reported. A 40-year-old male was referred to our hospital for further evaluation and treatment of left flank masses.

A case of pseudo-Bartter's syndrome due to intestinal malrotation.

Intestinal malrotation presenting beyond the neonatal period is associated with a multiplicity of symptoms, which are often non-specific and, consequently, are associated with delays in diagnosis. Pseudo-Bartter's syndrome, which mimics the manifestations of Bartter's syndrome, can be caused by a severe chloride deficiency secondary to vomiting, diarrhea, perspiration, diuretic abuse and so on. We describe a 6 year old boy who had been admitted to hospital three times during the preceding year.

[Extended tricuspid valve excision for active infective endocarditis associated with ventricular septal defect].

We report a patient of ventricular septal defect associated with a vegetations on the tricuspid valve and a perforation of the aortic cusp caused by infective endocarditis. Antibiotics could not relieve the high fever of this patient, and disseminated intravascular coagulation caused by sepsis and two-sided heart failure developed. She underwent extended tricuspid valve excision, aortic valve replacement and VSD closure during the active stage.

[Shortening of life expectancy in patients with membranous nephropathy--based on 20 years follow up study].

It is not certain whether the life expectancy of patients with membranous nephropathy is shorter than that of an age-matched healthy population. Forty-one patients (21 males, 20 females) aged between 16 and 70 years (average age: 33.3 years) were followed for 20 years.

[Endoscopic elecrocautery of the thoracic sympathetic chain: a minimal invasive surgical treatment].

The thoracic sympathectomy was performed with standard laparoscopic and urologic equipment. After intubation, the patient was placed in a half sitting position. A Surgineedle was introduced into the pleural cavity through a 1 cm incision at the intercostal space between the first and second rib.

Adrenocortical carcinoma with a giant pericardial mass.

A patient with a history of adrenocortical carcinoma presented with massive pericardial effusion and a giant pericardial mass. Death resulted from cardiac tamponade. At autopsy a large necrotic mass was histologically similar to the original adrenocortical carcinoma.

[A study of bladder function in benign prostatic hyperplasia].

A study of bladder function was performed on 106 patients with benign prostatic hyperplasia (BPH), 21 of whom had cerebrovascular disease (CVD). The incidence of overactive bladder in 21 patients with CVD was 57% and was significantly higher than the 25% in 86 patients without CVD. The incidence of cases having residual urine of over 100 ml, was in the order of low compliance bladder, overactive bladder and normal bladder.

[The relationship between pathological spreading factors and tumor size in 45 patients with renal cell carcinoma].

The relationship between pathological spreading factors (T3,4 V+, N+, M+) and tumor size was studied in 45 patients with renal cell carcinoma during the past 10 years from 1982. The incidence of having one or more factors was 0% for the 17 tumors smaller than 5 cm, but 75% for the 28 tumors over 5 cm. The mean diameter of the tumors having a T, V, N or M factor was significantly larger than that of tumors having no factor (T1,2V0N0M0).

[Clinical effects of distigmine bromide (Ubretid), a cholinesterase inhibitor, on micturition disturbance by benign prostatic hypertrophy--comparative study of distigmine bromide and the combination of distigmine bromide and adrenergic blocker].

We report the results of a comparative study on the clinical efficacy of the single use of distigmine bromide and its combined use with prazosin hydrochloride in the treatment of benign prostatic hypertrophy. The single use and combined use groups were administered 10 mg/day of distigmine bromide and the same with 1 mg/day of prazosin hydrochloride for a period of 8 weeks respectively. In the single administration group, marked improvement was found in one patient (9%), moderate improvement in 4 patients (36.

[Steroid pulse therapy in rapidly progressive glomerulonephritis].

In an attempt to clarify the indication and efficacy of the methylprednisolone pulse therapy (1000 mg x 3 times) for rapidly progressive glomerulonephritis (RPGN), 3 patients with the disease were carefully followed and the clinical course during and after the treatment were precisely analysed. According to the declination rate of reciprocals of serum creatinine (1/Cr), one patient were divided into the acute type (-1.00 x 10(-2) dl/mg/day or less) and the others into the subacute type (more than -1.

[Clinical studies of terodiline hydrochloride and clenbuterol hydrochloride for urinary frequency and incontinence].

The clinical effectiveness and safety of terodiline hydrochloride and clenbuterol hydrochloride were studied on 51 patients with neurogenic bladder, stress incontinence, unstable bladder and others, the chief complaints of which were urinary frequency or urinary incontinence. Overall improvement was graded as marked in 6 patients (11.8%), moderate in 20 patients (39.

[Clinical study of voiding disorders in patients with cerebrovascular accidents].

Cystometry and urethral pressure profile were determined in 41 patients (29 males and 12 females) with voiding disorders resulting from cerebrovascular accidents within one year after the episode. By clinical symptoms, they were classified into 3 groups, urge incontinence (14 patients, 34%), pollakisuria (10 patients, 24%) and dysuria (17 patients, 41%). Cystometrogram were classified into 3 types, hyperactive bladder (31 patients, 76%), normal bladder (5 patients, 12%) and hypoactive bladder (5 patients, 12%).

[Effects of methylprednisolone pulse therapy on progressive IgA nephropathy].

In order to estimate the effects of methylprednisolone pulse therapy on progressive IgA nephropathy, clinical parameters in eight patients with the disease were compared between before and after the therapy. In this study progressive IgA nephropathy was defined as follows; 24 hour urinary protein excretion was (++) or more and renal biopsy carried out just before the therapy revealed crescents, inevitably including cellular crescents, in 10% or more glomeruli observed. Methylprednisolone 1000 mg a day was intravenously administered for three consecutive days and the therapy was repeated with an interval of 4 days.