Prostate cancer-producing granulocyte colony-stimulating factor.

An 86-year-old man with a serum prostate-specific antigen level of 93.33 ng/ml was diagnosed as having cT3aN0M0 prostatic adenocarcinoma of Gleason score 9. Although the serum prostate-specific antigen responded well to combined androgen blockade, the cancer spread and lead to death 6 months after diagnosis.

Primary signet-ring cell carcinoma of the prostate.

We report a rare case of primary signet-ring cell carcinoma of the prostate in an advanced stage. A 62-year-old man with serum level of prostate-specific antigen at 364.70 ng/ml was diagnosed as having cT4N1M1c prostatic signet-ring cell carcinoma of Gleason score 5 + 4 = 9.

Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst.

Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease.

[Diagnosis of osteoporosis].

For the purpose of treatment of osteoporosis, we should not increase only bone mass, but should increase the quality of patient's life through decreasing the uncomfortable symptoms of osteoporosis and prevalence of fractures. For diagnosis of osteoporosis, we have to distinguish the other spinal diseases by the detailed physical examination, in addition to acquire the daily habit of nutrition and exercises. Radiographical findings of spines and laboratory examinations including measurement of deoxy-pyridinoline are important to diagnose osteoporosis.

[Factors inducing severe osteoporosis].

Among various factors advancing bone loss, immobility is the most remarkable cause to deteriorate osteoporosis. In the animal experiment, we could be obvious that immobilization of femur by suspension of rat tail reduced calcium content of bone through diminished blood circulation of bone, especially in femoral neck. In stroke patients who are often suffered from femoral neck fracture, bone mineral measurement revealed bone loss in paralyzed limb, in addition to healthy limb.

[Economical efficacy of measurement of bone mineral content for osteoporosis].

Bone mineral content is measured both to disclose a person with fragile bone in the elders and to recognize the effect of anti-osteoporotics in the treatment of osteoporosis. If the persons with fragile bone are given the anti-osteoporotics, applied the hip protectors and guided the prevention of fall, frequency of femoral neck fracture would be reduced to one eighth, indicating 300 billion yen reduction of annual medico-welfare costs in Japan. Although 10% of cost in medicament treatment of osteoporosis are consumed for the measurement of bone mineral content, efficacy proved 2% increase of bone mineral content during 4 months encourages to continue the treatment for both medical doctors and patients.

[Efficacy in medical cost of concurrent therapy for osteoporosis].

Medical cost of concurrent therapy (alphacalcidol and etidronate) for osteoporosis was compared with those of no treatment and single therapies (alphacalcidol or etidronate) . Although concurrent therapy reduced by one fifth in medical costs for low back pain and fractures, 3 to 6 times reduced medical costs were consumed in those for pharmaceutical therapies, radiological examinations and so on by concurrent therapy compared with no treatment and single therapies.

[Economical efficacy of physical exercises for osteoporosis].

From mean 12.5% increase of lumbar bone mineral density by one year's physical training, it is calculated to reduce the frequency of femoral neck fracture by 80% and the rate of falls by 50%. And 60% reduction of femoral neck fracture by physical exercise gains about 200 billion yen of medical and care costs annually, because a patient with femoral neck fracture consumes mean 1,320,000 yen for medical treatments and about 19% of the patients become bed-ridden state after the treatments for mean 5 years.

Reliability of MIBG myocardial scintigraphy in the diagnosis of Parkinson's disease.

Aim: To evaluate the reliability of [(123)I]meta-iodobenzylguanidine (MIBG) myocardial scintigraphy for diagnosing Parkinson's disease (PD).

Patients/methods: A series of 391 outpatients showing one or more parkinsonian-like symptoms was longitudinally followed up for accurate clinical diagnosis. MIBG scintigraphy was performed in the patients and 10 normal controls of similar age.

[A case of transitional cell carcinoma of the renal pelvis with adenocarcinoma producing CEA and CA19-9].

We report a case of invasive renal pelvic tumor with high serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9). An 86-year-old man presented with macrohematuria. Retrograde pyelography demonstrated a filling defect in right upper calyx, suspected of renal pelvic tumor.

Lewy bodies in the sinoatrial nodal ganglion: clinicopathological studies.

Lewy bodies (LB) are characteristic pathological findings for idiopathic Parkinson disease, and extracranial organs have also been known to exhibit these structures. Clinically, the possible involvement of LB in cardiac dysfunction has attracted attention based on the findings of studies using [123I] metaiodobenzyl guanidine (MIBG) scintigraphy. The purpose of the present study was to investigate the possible involvement of LB in heart disease.

A case of Sheehan's syndrome with panhypopituitarism due to the impairment of both the hypothalamus and the pituitary.

Sheehan's syndrome is thought to be caused by pituitary necrosis associated with massive hemorrhage at delivery. We report here on a patient with Sheehan's syndrome, showing a rare type of panhypopituitarism suggesting dysfunction of both the hypothalamus and the pituitary. Although the basal level of plasma ACTH was normal, that of plasma cortisol was low.

A case of micrographia after subcortical infarction: possible involvement of frontal lobe function.

Most reports of micrographia associated with focal brain lesions have related this finding to damage in the left basal ganglia. Here we describe the case of a 68-year-old man presenting with reversible micrographia accompanied by hypophonia in the absence of extrapyramidal signs after cerebral infarction in the left subcortical region. At the time of the patient's admission, diffusion-weighted magnetic resonance imaging sequence showed the lesion to principally involve the corona radiata, with some involvement of the putamen.

Lymphadenopathy of sinus histiocytosis mimicking metastatic bladder cancer: a case report.

A case of invasive bladder cancer accompanied with enlarged pelvic lymph nodes, which were interpreted as metastasis, is reported. The lymphadenopathy eventually regressed spontaneously while the bladder cancer increased in size. Total cystectomy and pelvic lymph node dissection were performed.

[Clinical practice guidelines for diagnosis and treatment of osteoporosis].

The Japanese Society for Bone and Mineral Research organized a committee to make a new criteria of diagnosis for osteoporosis in 2000. In the criteria, cases who show atraumatic fractures in demineralized bone are made a diagnose of osteoporosis. In the cases who show no atraumatic fractures, patients whose bone mineral densities are less than 70% of mean density of young adult persons or whose X-ray films indicate coarse or unclear longitudinal trabeculae in vertebral body, are also made a diagnose of osteoporosis.

Outcomes of hip fracture surgery in patients aged > or = 90 years.

The outcomes of 60 patients aged > or = 90 years with hip fractures who underwent surgery between 1995 and 1998 were reviewed. Average follow-up was 21 months (range: 4-47 months). All patients experienced pain relief within 2 months postoperatively.

[Bone and joint diseases in the elderly].

As a current attention of the medical treatment has been paid to improve guality of the life rather than to save the life of the patient, so the treatment of bone and joint diseases, which are not ordinarily fatal and deteriorate quality of the life of the patient, would become important in the aged society of 21 century. In a strategy to improve the quality of life in the patient with osteoarthritis, disease modifying anti-osteothritis drugs are investigated for primary prevention and complete recovery of osteoarthritis. In osteoporosis, a characteristic bone disease of the aged, aims of the treatment have been changed from freeing of pain in the nineteen sixties, increase of bone mass in the nineteen eighties and reduction of the fracture rate in the nineteen nineties to improve of quality of the life through decrease of pain and fracture in 21 century.

[Antibiotic-associated colitis in senile patients].

Antibiotic-associated colitis (AAC) is a relatively frequent disorder in the senile population. Because of the change of life style in the elderly, the clinical pattern of AAC may be varied. The causative antibiotics, duration of administration, duration from taking antibiotics to onset of symptoms, background disorders, symptoms, laboratory data, therapies and prognosis in patients with AAC were investigated retrospectively in 54 cases of averaging 80.

Conservative treatment of Garden stage I femoral neck fracture in elderly patients.

We reviewed 38 patients aged 65 years and older with fresh Garden stage I femoral neck fractures treated nonsurgically to determine factors that influence fracture union. The mean follow-up period was 20 (range 6-86) months. Twenty-three (61%) fractures united within 6 months after injury, while 15 (39%) failed to unite.