[A case of gastro-renal-shunt induced non-cirrhotic recurrent hepatic encephalopathy effectually treated by balloon-occluded retrograde transvenous obliteration].
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Balloon Occlusion↗
Biomedical subjects
T Mogami
Publications and source records attributed to T Mogami.
Correction of completely buried penis using the modified preputial island pedicle flap method.
The buried penis is a rare congenital abnormality caused by a deficiency of penile shaft skin and abnormal attachments of the dartos fascia to Buck's fascia. The basis for surgical correction is directed at freeing the penile shaft from abnormal dartos attachments, refixing dartos fascia to Buck's fascia to prevent retraction of the penis, and providing adequate shaft skin coverage with the inner preputial skin. The authors report a modified preputial island pedicle flap method for correcting the completely buried penis performed on 2 patients (ages 9 months and 1 year) at Nagoya City University Medical School.
Humans↗
49,XXXXY syndrome with hydronephrosis caused by intravesical ureterocele.
A 1-month-old boy was referred to our hospital with right hydronephrosis. Excretory urography showed poor visualization of the right kidney and a filling defect in the bladder. Chromosomal analysis of peripheral blood revealed a karyotype of 49,XXXXY, and a diagnosis of 49,XXXXY Klinefelter s syndrome associated with hydronephrosis caused by intravesical ureterocele was made. 49,XXXXY Klinefelter s syndrome with anomalies of the urinary tract is extremely rare, and only 2 cases have been reported so far.
Humans↗
[A clinical study on virilization of external genitalia in congenital adrenal hyperplasia].
PURPOSE: In the newborn female with congenital adrenal hyperplasia (CAH), there are variable degrees of clitoral enlargement and virilization of the urethra. In order to investigate the factors that cause these variations, the degree of musculinization of the external genitalia in 44 patients with CAH was studied retrospectively. PATIENTS AND METHODS: This study includes a total of 44 patients with CAH aged 2 months to 12 years and 11 months old who had consulted Nagoya City University Hospital from 1977 to 1994. The length of clitoris on the first consultation was compared with the age and its change was followed. Also, the relationship among the length of clitoris on the first consultation, the degree of urethral virilization, the clinical forms i.e. salt-losing or simple-virilization, and the glucocorticoid hormonal condition were investigated with each other. In 5 pairs of sisters, the length of clitoris on the first consultation was compared within each pairs, and also the degree of urethral virilization was compared. RESULTS: The clitoral length on the first consultation was significantly correlated with the age (y = 1.8 x + 1.8, r = 0.7, p < 0.0001). The mean clitoral length at birth calculated from these data was 18 mm, which is as large as that of adult female one, and the clitoral enlargement rate was 1.8 mm/yr. The correlation was not clear between the clitoral length and the degree of urethral virilization, the clinical forms, and the glucocorticoid hormonal condition, either. On the other hand, the degree of urethral virilization was comparable within clitoral length was not comparable within them. CONCLUSIONS: The urethral virilization was suggested to be determined by the internal hormonal environment during embryonal stage which was shared by the each pair of sisters. On the Other hand, the clitoral length was depend on the patient's age though the factor which determined the length was not apparent. These facts indicated that, not only the severely musculinizing cases, but also the new born female with mildly virilizing urethra should be followed strictly not to undergo the clitoral enlargement.
Adrenal Hyperplasia, Congenital↗
Results of closure of urethrocutaneous fistulas after hypospadias repair.
BACKGROUND: Urethrocutaneous fistulas are one of the major causes of morbidity after hypospadias repair. METHODS: During the last 2.5 years, 26 patients underwent repair of 41 urethrocutaneous fistulas. These fistulas were repaired by a 3-layered closure method, by using meticulous surgical techniques aided by optical magnification. In large fistulas, a dermal subcutaneous flap was created and brought over the surgically repaired urethral fistula. RESULTS: Twenty-four of the 26 patients with urethrocutaneous fistulas after hypospadias repair had fistula closure, with a 92% success rate. CONCLUSION: A high success rate was obtained with a multilayered closure using meticulous techniques to repair urethrocutaneous fistulas.
Adolescent↗
Malignant mesodermal mixed tumor of the ureter.
Malignant mesodermal mixed tumor comprised of epithelial and nonepithelial components is rarely encountered in the urological field. Only 6 cases of malignant mesodermal mixed tumor of the ureter have previously been reported in the literature. We recently encountered a 7th case of malignant mesodermal mixed tumor of the ureter and describe the case in detail. The etiology of malignant mesodermal mixed tumor is also discussed.
Aged↗
[Operative methods for severe hypospadias].
BACKGROUND: Pediatric urologists tend to use one-stage procedures for the repair of hypospadias. As there are various types of hypospadias, we cannot repair this disease with a single modality. It is difficult to estimate the exact length of the neourethra in cases of severe hypospadias before surgery. METHODS: After a circumferential incision is made about the coronal sulcus and the chordee is completely released, the distance between the glans tip and the retreated native meatus is measured to determine the length of the neourethra. Urethroplasty with the method of Transverse Preputial Island Flap (TPIF) is selected when the distance ranges from 3 to 4 cm, while urethroplasty using with modified OUPF IV (Koyanagi) is selected in cases of more than 4 cm. RESULTS: We performed surgery on 14 hypospadiac patients with chordee between April 1996 and April 1997. Eight patients underwent urethroplasty using the TPIF method and 6 underwent urethroplasty with the method of the modified OUPF IV. With the TPIF methods, 7 to 8 patients underwent repair successfully and one experienced urethrocutaneous fistula, while 5 of 6 treated by the modified OUPF IV method has successful repairs and meatal stenosis occurred in one patient. CONCLUSION: Even if we encounter severe hypospadias, we can treat these patients with one stage repair alternatively. A relatively high success rate was obtained with both methods to repair severe hypospadias.
Child↗
[Usefulness of 99mTc-MIBI SPECT in the metastatic lesions of thyroid cancer].
99mTc-MIBI is widely used as a tumor-seeking agent for parathyroid tumor, lung cancer, etc. We tried to detect the metastatic lesions of thyroid cancer by 99mTc-MIBI SPECT and evaluated 131I-uptake in the region of 99mTc-MIBI accumulation. Twenty-seven cases of thyroid cancer (23 papillary adenocarcinoma, 3 follicular adenocarcinoma, 1 unknown) were examined by 99mTc-MIBI. All cases were confirmed by surgery. Thyroglobulin was measured in all cases before 99mTc-MIBI SPECT. 131I-therapy (4.5-5.5 GBq) was performed on 24 patients and whole body scintigram was taken 7-10 days after. Thirty minutes after an injection of 99mTc-MIBI (740 MBq), SPECT with a three-head gamma camera was performed. Abnormal accumulation of 99mTc-MIBI was noted in 14 patients, all cases detected on CT or MRI. In 11 of the 13 cases in which accumulation was not visualized, no metastasis was detected. Most cases of abnormal accumulation on 99mTc-MIBI showed a high level of thyroglobulin. Metastatic lesions of follicular adenocarcinoma in three patients (right humerus, axillary region and sternum) showed strong accumulation of 99mTc-MIBI, and 131I was strongly taken up in these lesions. 131I was also taken up in the metastatic lesions of papillary adenocarcinoma with marked accumulation of 99mTc-MIBI. 99mTc-MIBI did not accumulate in a case with diffuse pulmonary uptake of 131I. 99mTc-MIBI SPECT could detect occult metastatic lesions in the soft tissue more clearly than CT or MRI. In conclusion, 99mTc-MIBI study might be useful as a follow-up study of patients after surgery for thyroid cancer.
Adenocarcinoma, Follicular↗
[Transurethral incision for ureterocele in children].
Transurethral incision (TUI) was performed as the initial treatment in 10 children with ureteroceles. Three patients had ureteroceles associated with a single ureter. TUI relieved hydronephrosis and preserved renal function in all 3 cases. Urinary tract infection developed in no patients. However, all the patients required an antireflux operation because of postoperative vesicoureteral reflux (VUR). Seven children had a total of 8 ureteroceles associated with a duplex system. TUI resulted in preservation of the upper pole function in 6 of the 8 ureteroceles. Urinary tract infections and VUR developed in 3 and 7 patients, respectively. Common sheath reimplantation was performed in 2 ureteroceles. TUI relieves obstruction before the onset of devastating infections although it carries the risk of postoperative VUR. We recommend TUI as the initial treatment for ureteroceles associated with both single and duplex systems.
Adolescent↗
Transinguinal laparoscopy for nonpalpable testis.
BACKGROUND: About 20% of all undescended testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of examining a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration performed for nonpalpable testis. METHODS: Twelve children with 14 nonpalpable testes (2 children had bilateral nonpalpable testes) were considered for a novel method of laparoscopy. We performed laparoscopy through the internal inguinal ring after opening the inguinal canal. RESULTS: Inguinal exploration revealed the testis or its remnant in 5 patients, and thus prevented unnecessary laparoscopy in these individuals. Transinguinal laparoscopy identified the anatomy in 7 patients. Four of the latter were found to have blind-ending vas deferens and spermatic vessels, while in 3 patients, the testes were located in the peritoneal cavity. CONCLUSION: Transinguinal laparoscopy may become the accepted method for managing nonpalpable testes, as inguinal exploration can eliminate the need for laparoscopy in some cases, and the visualization achieved with transinguinal laparoscopy is just as good as that with conventional laparoscopy.
Child↗
Detection of sex-determining region in a male with chromosomal abnormality (46,X+mar) and hypospadias.
A 1-year-old boy was referred to us because of abnormal external genitalia; that is, his penis was kinked toward the perineal region. We diagnosed hypospadias. Chromosomal examination was performed on a sample of peripheral blood, the karyotype was 46,X+mar. Detailed karyotypic analysis revealed that the short arm of the marker chromosome originated on the ninth chromosome, but we could not determine whether the long arm was part of the Y chromosome, even with the use of quinacrine mustard. The sex-determining region of the Y was detected using the polymerase chain reaction method, which suggested that the long arm of the marker chromosome was delivered from the short arm of the Y chromosome.
Base Sequence↗
[One-stage urethroplasty with the modified OUPF IV for proximal hypospadias].
BACKGROUND: We previously performed one-stage urethroplasy with OUPF IV in 17 patients with proximal hypospadias and experienced meatal stenosis in 3 and meatal regression in 2. METHODS: Because these complications seemed to be caused by diminished vascularity, we modified the technique to preserve the vascularity to the peripheral site of the neourethra. The modified OUPF IV (Koyanagi) was used to treat 6 patients with proximal hypospadias during the last 3 months. RESULTS: Urethrocutaneous fistulas developed in 2 patients but meatal stenosis and meatal regression did not occur. CONCLUSION: We think this modification is suitable for severe proximal hypospadias.
Child↗
Laparoscopic gonadectomy for testicular feminization syndrome.
Laparoscopic gonadectomy was performed on a patient with complete androgen insensitivity (testicular feminization syndrome). In the case presented here, although the gonads were free, the omentum which was adhering to the right inguinal ring, possibly as a result of previous inguinal hernia repair, obscured the right gonad. The left gonad was located behind the sigmoid colon. We present our laparoscopic experience in managing this case of testicular feminization syndrome.
Adult↗
[Pseudo-Bartter syndrome without hypopotassemia: a case with unilateral multicystic dysplastic kidney and congenital contralateral hyronephrosis].
A 2-month-old girl having a left multicystic dysplastic kidney with contralateral mild hydronephrosis is described. Furosemide was administered orally because of hyperpotassemia during the period between 1 month and 7 months of age. Peripheral plasma renin activity and plasma aldosterone activity increased at the age of 6 months, and ultimately reached the peak at 9 days after discontinuation of furosemide at the age of 7 months. Peripheral plasma renin activity and plasma aldosterone activity were normalized at the age of 11 months. Blood pressure during the whole period was normal. Contralateral hydronephrosis was improved gradually. The level of serum creatinine became normal at the age of 50 days. A case with a high level of plasma renin and aldosterone activity temporarily induced by furosemide was reported. Pathophysiology of pseudo-Bartter syndrome without hypopotassemia due to furosemide is discussed.
Aldosterone↗
[A case of adult pure yolk sac tumor of the testis achieving pathological complete response by chemotherapy].
We report a case of pure yolk sac tumor of the left testis in a 22-year-old male. He consulted a physician with left back pain and induration of his left scrotal content in December, 1992. Intravenous pyelography (IVP) revealed left hydronephrosis. Computerized tomography (CT) revealed para-aortic lymph node swelling and lung metastases. Left high inguinal orchiectomy was performed. Histopathological diagnosis was pure yolk sac tumor. After two courses of "COMPE" chemotherapy consisting of cisplatin, vincristine, methotrexate, peplomycin and etoposide, two courses of "high dose "COMPE" chemotherapy and three courses of "high dose COME" chemotherapy without peplomycin, he achieved a partial response (the regression rate of the pulmonary metastases and the retroperitoneal lymph node metastasis were 100% and 96.0% on CT, respectively) and the residual masses in the retroperitoneum were removed. Necrosis and xanthogranulomatous fibrosis were found in the resected material. The patient showed no evidence of disease two years after chemotherapy.
Adult↗
[Experience with one stage repair of hypospadias and chordee without hyposradias using free graft of prepuce].
We treated 14 patients with moderately severe hypospadias and chordee without hypospadias using a free graft of prepuce by a modified Devine-Horton technique, between September 1993 and April 1995. There were 12 primary cases and 2 secondary cases in which prior operations had already been done. Four (33%) of the primary cases required a second procedure; 3 for urethrocutaneous fistula and 1 for urethral shrinkage. Both of the secondary cases needed further procedures; 1 for meatal stenosis and 1 for urethral stricture and diverticula. Although the need for reoperation is unfortunately high, six of the 7 recently treated patients experienced no complications. Thirteen of the 14 patients (93%) achieved excellent functional and cosmetic results with 1 or 2 procedures. We believe the use of free grafts allows a better functional and cosmetic outcome because the secondary torsion and bulkiness of the penile shaft caused by a vascular pedicle are eliminated.
Child↗
String field theory in the temporal gauge.
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Journal Article↗
[A case of adult giant hydronephrosis--a study of indication for kidney conservative operation].
A 40-year-old man with the complaint of right lower abdominal pain was admitted to our hospital. Urological examinations revealed right giant hydronephrosis and ureteropelvic junction (UPJ) obstruction caused by an aberrant artery. Radiography showed approximately 3,500 ml of fluid in the renal pelvis. Preliminary nephrostomy was performed and about 2,300 ml of fluid was removed. Enhanced computed tomography, angiography, radioisotope examination and pelvic urine analysis indicated that conservative operation in this case was possible and a pyeloplasty was performed. Two years after the operation the right renal function showed improvement with no complication of hypertension. Although nephrectomies have been performed in adult cases with giant hydronephrosis it is important to consider indication for conservative operations in those cases.
Adult↗