Hematospermia: a new etiology of clinical interest

Ten Spanish male tourists developed hematospermia and ultrasonographic evidence of involvement of the prostate and/or seminal vesicles after recreational exposure in bodies of fresh water in the Dogon country of Mali. Schistosoma eggs were detected in the ejaculate of five men, in the others, eggs were observed in the urine or feces. Three different species were observed: S. intercalatum, S. haematobium, and S. mansoni. Hemospermia and clinical prostatitis may be frequently unrecognized clinical manifestations of the early stages of infection in previously nonexposed persons. Travelers to endemic areas should be advised on the potential dangers of swimming and other exposure in bodies of freshwater.     

Massive hemospermia: a new etiology and simplified treatment

Hemospermia is a common urologic symptom that is usually benign and self-limited, and required no clinical investigation. Massive hemospermia causing hematuria, with clot formation and occasional urinary retention, occurs in a subset of patients. Three patients are reported in whom cystourethroscopy demonstrated nonvaricose abnormal posterior urethral vessels. Treatment consisted of fulguration of the vessels. One patient was cured, 1 had no symptoms for 3 years and 1 improved slightly. Endoscopically, this is a safe simple outpatient surgical procedure that is recommended for massive hemospermia due to abnormal posterior urethral vessels.     

CSF testosterone and 5-HIAA correlate with different types of aggressive behaviors

We studied the potential roles of testosterone and serotonin in various forms of aggressive and violent behaviors by measuring each biochemical and behaviour in free-ranging adolescent male nonhuman primates. Our results showed that (1) CSF free testosterone concentrations were positively correlated with overall aggressiveness, but not with measures of impulsivity. (2) CSF 5-HIAA concentrations were negatively correlated with impulsive behavior, and severe, unrestrained aggression, but not with overall rates of aggression. High rates of impulsive behavior were positively correlated with severe, unrestrained aggression, but not overall rates of aggression. (3) Dimensional analyses showed that while subjects with low CSF 5-HIAA exhibited high rates of aggression, high CSF testosterone further augmented rates and intensity of aggression in subjects with low CSF 5-HIAA. We conclude that high CSF free testosterone concentrations are associated with competitive aggression, while low CSF 5-HIAA concentrations are associated with severe aggression which results from impaired impulse control, and perseverance.     

Hirschsprung''s disease: a search for etiology

Expression of proliferating cell nuclear antigen (PCNA) as well as p53, bcl-2 and C-erb B-2 genes protein products on Reed-Sternberg/Hodgkin's (R-S/H) cells was analyzed by immunohistochemistry in 65 patients with Hodgkin's disease (HD). Their significance as markers of clinical malignancy and prognostic factors was evaluated. Positive reaction for PCNA was present in 57 cases (87.7%), for p53 in 42 (64.6%), for bcl-2 in 41 (63.1%), and for C-erb B-2 in 38 cases (58.5%) of HD. The high proliferate PCNA index and high expression of p53 and bcl-2 correlated with poor response to the treatment. Expression of both p53 and bcl-2 oncoproteins negatively influenced overall survival and disease free survival. Indexes of PCNA, p53 and bcl-2 were significantly higher in patients with advanced disease then in early clinical stages. In LP type of HD the lowest indexes of PCNA or bcl-2, and even lack of bcl-2 expression on R-S/H cells were observed. There was no correlation between expression of C-erb B-2 and response to the treatment, time of survival, clinical stage or histopathological types of HD. Statistical analysis let us to the conclusion, that indexes of PCNA, p53 and bcl-2 expression can be taken into consideration as a new prognostic factors in Hodgkin's disease. C-erb B-2 protein expression seems to be of no value for prognosis in HD.     

5 a day for better health: a new research initiative

Liver function tests and liver morphology were studied in 18 patients with cystic fibrosis (CF) for a period of 3 years. The patients were 5-19 years of age at the start of the study. Nine patients received regular supplementation of essential fatty acids (Intralipid) and nine sex- and age-matched patients, with as similar clinical status as possible but without fat emulsion treatment, were followed as controls. There were no significant differences between the two groups with regard to the parameters of liver function, including determinations of bile acids in serum and urine. Histological examinations of liver biopsies suggested less progression of liver disease in the fatty acid supplemented group, including fatty infiltration of the hepatocytes, evaluated morphometrically. The results show that regular supplementation of fat emulsions has no negative effects in the liver of patients with CF, and the lessening of progression of liver damage suggests that essential fatty acid deficiency might contribute to the liver damage in this disease.     

CSF levels of HVA and 5-HIAA in drug-free schizophrenic patients and healthy controls: a prospective study focused on their predictive value for outcome in schizophrenia

Recent progress in the studies of the olfactory system, especially in the molecular biological studies, makes it one of the useful sensory model systems for understanding neural mechanisms for the information processing. In the olfactory bulb, the primary center of the olfactory system, glomeruli are regarded as important functional units in the transmission of odorant signals and in processing the olfactory information, but have been believed to be composed by only a small number of neuronal types and thus to be simple in their neuronal and synaptic organization. However, accumulating morphological data reveal that each type of neurons might further consist of several different subpopulations, indicating that the organization of glomeruli might not be so simple as it was believed. Here we describe an aspect of the structural organization of glomeruli, focusing on the heterogeneities of periglomerular neurons in mammalian main olfactory bulb.     

Granular cell tumor of the duodenum: a case report

Granular cell tumor (GCT) in the duodenum is an extremely rare disease: only one case has been listed in a review, to date. We reported a 47-yr-old Japanese male case with GCT of the duodenum. Clinically, melena caused by bleeding from the tumor was the only symptom. The tumor cells showed abundant, granular eosinophilic cytoplasm. Although this tumor was clinically and histologically benign, highly developed tumor microvessels were demonstrated both angiographically and histologically, suggesting malignant potential of the tumor.     

Localized amyloid tumour of the duodenum : a case report

Amyloid tumours in the gastrointestinal tract are rare. A case is presented of a localized amyloid tumour in the duodenum, which was removed by loop resection during ERCP.     

Mechanisms of elevation of serum and urinary concentrations of soluble thrombomodulin in diabetic patients: possible application as a marker for vascular endothelial injury

Serum and urinary levels of soluble thrombomodulin (TM) were measured in 71 patients with non-insulin-dependent diabetes mellitus (NIDDM) and 132 age-matched control subjects to elucidate the mechanisms involved in increased TM levels. We compared the TM level with urinary albumin excretion (UAE), creatinine (Cr) clearance, and indices of renal tubular damage such as urinary beta2-microglobulin. Serum TM was significantly higher in diabetic patients versus control subjects (P < .001) regardless of whether the patients had diabetic nephropathy. Urinary TM levels were also higher in diabetic patients than in control subjects (P < .001). Serum TM in diabetic patients was correlated positively with serum Cr and UAE and inversely with the Cr clearance rate (P < .001, respectively). The urinary level of TM in diabetic patients was significantly correlated with 24-hour glucose excretion and the serum level of 1,5-anhydroglucitol (1,5-AG) (P < .001). However, no correlations were found between urinary TM levels and renal function in diabetic patients. There was also no correlation between serum and urinary levels of TM in the patients. These results suggest that although the serum TM level is influenced by an impairment of the renal clearance of TM, this parameter may be a useful marker for vascular endothelial injury in diabetic patients. On the other hand, since the elevated urinary level of TM in the patients paralleled their urinary excretion of glucose, urinary TM levels do not correlate with vascular endothelial injury in diabetic patients.     

Metanephric adenoma of the kidney: a case report

Metanephric adenoma (MA) of the kidney is an uncommon benign epithelial tumor of the kidney that presents at any age. The histology of the lesion is well established, but the imaging findings have been described in only a few cases. We report the sonographic and computed tomographic appearance of MA in a 9-year-old girl to increase awareness among radiologists of this entity. Its recognition may facilitate nephron-sparing surgery.     

Estimation of the flow of microbial nitrogen to the duodenum using urinary uric acid or allantoin

Data were collected from six experiments using duodenally cannulated Holstein dairy cows (88 combinations of cow and period) to evaluate the relationship between urinary purine metabolites and microbial N flow. Experiments evaluated the effects of dietary factors on microbial N production, which included 1) varying concentrations of ruminally degradable protein and nonstructural carbohydrates, 2) supplemental sources of protected amino acids, 3) grass silage treated with fibrolytic enzymes, 4) bacterial inoculation of corn silage, and 5) ruminal starch availability as affected by corn silages of varying maturity. The coefficient of determination for individual experiments that measured the relationship between microbial N flow and allantoin or uric acid excretion in urine ranged from 0.01 to 0.68 and 0.02 to 0.82, respectively. Across all experiments, the coefficients of determination between microbial N flow and allantoin or uric acid excretion in urine were r2 = 0.002 and 0.11, respectively. Removal of data from one experiment improved the overall coefficient of determination between microbial N flow and urinary uric acid to r2 = 0.32. Urinary allantoin excretion across experiments was negatively correlated with microbial N flow, but urinary allantoin excretion within experiments was positively correlated with microbial N flow. Uric acid excretion in urine was positively correlated with microbial N flow across and within experiments, except for one experiment. Our data demonstrate that uric acid excretion in urine can be used to predict microbial N production, except in early lactation, and that urinary allantoin excretion cannot be used to predict microbial N production accurately among cows at different stages of lactation.     

Primary malignant lymphoma of the duodenum: report of a case

We present a case of long-term survival in primary malignant lymphoma of the duodenum treated with a curative surgical resection and post-operative chemotherapy. A 72 year-old man was admitted to our hospital complaining of epigastric discomfort. Endoscopy revealed an ulcerative tumor in the duodenal bulb. The tumor was diagnosed histologically as malignant lymphoma by endoscopic biopsy. A distal gastrectomy and duodenal bulb resection were performed with lymph nodes dissection. The tumor was histologically classified as B-cell phenotype, large cell, immunoblastic lymphoma of high grade, according to the Working Formulation. The patient received CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy after the operation, and he has no sign of recurrence during a follow-up period of 6 years.     

Indwelling catheter and risk of urinary infection: a clinical investigation with a new closed-drainage system

In 108 cases a postmortal pancreatography followed by histological examination was performed. The size of the pancreas could be measured on X-ray films after complete acinar filling. In normal cases organ size was proportional to the diameter of the duct, the diameter ranging between 2 and 4 mm (average 3,7 mm). In subjects with chronic pancreatitis, the diameter varied from 4 to 8 mm (average 5.7 mm). From these results it could be concluded, that the S/D-quotient (pancreatic surface seen on X-ray in cm2 divided by the greatest diameter of the main duct in mm) might be an aid in establishing the diagnosis of chronic pancreatitis in doubtful cases. In chronic pancreatitis the width of the duct generally increases while the size of the organ decreases due to scar formation, thereby clearly reducing the S/D-quotient. The average quotient of our normal cases was 24,2 and that for cases of chronic pancreatitis was 12,0.     

Syringomatous adenoma of the nipple: report of a case

BACKGROUND: Previous research has shown that the suppression of theta wave activity and the enhancement of sensorimotor rhythm (SMR) through electroencephalographic (EEG) biofeedback is an effective treatment for epilepsy. The current research reports the results of EEG biofeedback treatment for patients presenting with seizure behaviors in the absence of eliptiform EEG activity. METHODS: In addition to psychotherapy, 3 patients, 2 women and 1 man, were trained, using EEG feedback once per week, to reduce the ratio of theta band to SMR band EEG amplitudes. RESULTS: The results showed that reductions in seizure activity were related to reductions in the theta-SMR ratio. CONCLUSIONS: These findings support the view that theta-SMR feedback training, in conjunction with psychotherapy, is an effective adjunctive treatment for pseudoseizure disorder.     

What's new: the AHCPR guideline update on urinary incontinence

The Agency for Health Care Policy and Research (AHCPR) released their first updated guideline in March, 1996. Three documents were released: the Clinical Practice Guideline, Urinary Incontinence in Adults: Acute and Chronic Management; the Quick Reference Guide, Managing Acute and Chronic Urinary Incontinence; and the Patient Guide, Understanding Incontinence. The new areas are outlined and addressed. Unlike the 1992 version, the update emphasizes the problem of urinary incontinence (UI) in a specific population, those with chronic "intractable" incontinence. It provides an algorithm in the Quick Reference Guide for selecting appropriate behavioral, pharmacologic, and surgical treatments and supportive devices for use in managing UI. The concept of "prevention" of UI and the promotion of healthy bladder habits is introduced. The updated guideline developed recommendations for each assessment and treatment method. Specific interventions that can impact individuals with chronic "intractable" incontinence are discussed including toileting assistance programs, physical and environmental alterations, fluid and dietary management, management of nighttime voiding, and other measures and supportive care. Skin care and social and organizational environmental factors are also discussed. In August, 1996 the AHCPR released two additional, original documents, the Caregiver Guide, Helping People with Incontinence, and Alert for Directors of Nursing, which are briefly discussed.     

Modulation of non-adrenergic non-cholinergic inhibitory transmission in rat duodenum: role of opiates and 5-hydroxytryptamine

In rat duodenal segments in vitro, electrical field stimulation induced a TTX-sensitive relaxation in the presence of atropine and guanethidine. A correlation between the amplitude of the evoked response and stimulus frequency was observed. Opioid peptides DAGO, DPDPE and DYN caused a dose-dependent increase in the amplitude of the response to EFS. Naloxone shifted to the right the dose-response curves for each opioid peptide significantly enhancing the ED50 values. The amplitude of the response to EFS was enhanced, dose-dependently, also in the presence of 5-HT. Such an effect induced by 5-HT was prevented by 5-HT receptor desensitization, but persisted unchanged after naloxone pretreatment. Opioids failed to affect the response to EFS after 5-HT receptor desensitization. Results suggest that in rat duodenum opioids modulate NANC inhibitory neurotransmission, indirectly the release of 5-HT.     

Papillary adenoma of the large intestine: a historical perspective

Aedes albopictus (Skuse) is expanding its distribution in the United States and elsewhere, and a better understanding of its population regulation is needed. A field experiment under seminatural conditions determined that density had a negative effect and food level a positive effect on immature survival, duration of development, and female size at emergence. A summary index (r') indicated that population growth also depended on density and food availability. These data can be used to estimate the relationships needed in the development of mathematical models for Ae. albopictus.     

Intramural haematoma of the duodenum: a rare cause of duodenal obstruction

Intramural haematoma is a rare cause of duodenal obstruction. Its most common cause is abdominal trauma. Diagnostic difficulty arises if the patient or the child's parents fail to mention the episode of trauma, regarding it as an unrelated or insignificant event, as in the presented case. Computed tomography is the imaging modality of choice. Intramural duodenal haematoma is best treated conservatively, since operative treatment is associated with a high complication rate and longer hospitalization.     

A new technique for sacral nerve stimulation: a percutaneous method for urinary incontinence caused by spinal cord injury

We report a 40-year-old Japanese man with a creeping eruption caused by a larva of the nematode suborder Spirurina type X. He had eaten raw small squid (hotaruika) 4 weeks before the serpiginous erythematous eruption appeared on his abdomen. Routine laboratory tests revealed only slight eosinophilia in his peripheral blood. Although we could not find the larva in an excised skin specimen, an indirect immunofluorescence test confirmed the presence of antibodies against larvae of the suborder Spirurina type X. We review 28 reported cases in Japan which showed that creeping eruption caused by larvae of the suborder Spirurina type X has the following clinical characteristics: an incubation time of 1-4 weeks; a migratory, well-defined, narrow, serpiginous erythematous eruption; and only slight peripheral blood eosinophilia. Excision of the advancing end of the track was curative in our patient.