We report the case of a 37-year-old Japanese man who presented with a left lower abdominal mass that was initially interpreted clinically as an inguinal hernia. The patient reported a swelling in his left lower abdomen over the past 6 months. Magnetic resonance imaging revealed a left inguinal mass extending from the left spermatic cord to the left inguinal subcutaneous layer. Local excision was performed, with a preoperative diagnosis of benign soft tissue tumor. Histopathological diagnosis revealed aggressive angiomyxoma (AAM), and no recurrence was observed 6 months after surgery. AAM is a rare tumor which most commonly occurs in the pelvis or perineum of premenopausal women, with extremely rare cases in men. The findings from previously reported cases and our case suggest that AAM should be considered in patients with an inguinal or scrotal swelling with a suspicious soft tissue tumor.
Autofluorescence observations enable scientists to sensitively identify various lesions. Non-steroidal anti-inflammatory drugs such as aspirin and indomethacin are well known to induce gastric mucosal injuries. Our purpose was to clarify whether the observation of mucosal autofluorescence could help us to recognize indomethacin-induced gastric lesion formation. Gastric mucosal fluorescence intensity and gastric lesion scores were time-sequentially measured after indomethacin treatment in rats. To identify the localization of autofluorescent substances, stomach cryosections were observed with an epifluorescence microscope. Fluorescent substances from damaged tissue were also analyzed by high-performance liquid chromatography. In addition, to elucidate whether oxidative stress directly generates fluorescent substances from heme, we investigated the reaction between hydrogen peroxide and hemoglobin in a cell-free system. Treatment with indomethacin induced gastric lesions by tissue peroxidation, with mucosal fluorescence intensity increasing time-dependently. The fluorescence products were mesoporphyrin and protoporphyrin, and they were localized in disrupted mucosal tissue. In the cell-free system, porphyrins were directly generated by hydrogen peroxide from hemoglobin. These findings indicate that indomethacin treatment increased the intensity of porphyrin fluorescence. Gastric mucosal lesion formation can be sensitively detected with fluorescence observations.
To develop a new method of detecting cellular injury caused by oxygen radicals, we studied endogenous fluorescence from the cultured cells of a rat gastric mucosal epithelial cell line. Measurement with an ultra-high sensitivity camera-image processor system under an inverted epifluorescence microscope showed that the fluorescence intensity of the cells increased time- and dose-dependently after the addition of hydrogen peroxide (H2O2), an oxygen radical precursor, to the medium. This increase was inhibited by the presence of catalase. Phase-contrast and fluorescence microscopy revealed that the fluorescence was emitted from granular substances in the cytoplasm of the injured cells. The spectral pattern of excitation and emission indicated that the fluorescent substances were flavins. In cell-free experiments, glutathione reductase which has flavin adenine dinucleotide (FAD) at the active site, increased in fluorescence after incubation with H2O2 in the presence of reduced glutathione and glutathione peroxidase. These findings indicate that FAD in the cytoplasm of cells injured by H2O2 increased in endogenous fluorescence according to the extent of injury, and suggest that fluorescence measurement may be a simple method in cellular toxicology to detect oxygen radical-induced injuries.
Intraurethral catheters are effective in the treatment of elderly patients with benign prostate hyperplasia (BPH) who have severe complications. However, it is not easy to measure the length of the prostatic urethra and to determine an appropriate location for the urethral catheter using only fluoroscopy, especially in patient with severe mid-lobe enlargement. We attempted to place a shape-memory alloy intraurethral catheter (MEMOKATH) by transrectal ultrasonography and fluoroscopy to measure the precise length of the prostatic urethra and to determine an appropriate location for an intraurethral catheter placement. Patients were given urethral infiltration anesthesia with 2% lidocaine hydrochloride jelly and placed in the supine position. Both transrectal ultrasonography and fluoroscopy were performed to observe the bladder neck, the apex of the prostate gland, and the prostatic urethra. Transrectal ultrasonography was shown to depict them more clearly than fluoroscopy. Transrectal ultrasonography was also shown to be more suitable than fluoroscopy for measuring the prostatic urethra length, as well as for accurately positioning the MEMOKATH stent, especially in cases of BPH with mid-lobe enlargement. The MEMOKATH stent was placed in 7 patients with BPH. Urethral catheters had been put in place in 6 of these patients because of urinary retention, and large amounts of residual urine were found in the remaining patient. Three patients had severe mid-lobe enlargement. All patients were able to urinate without much residual urine after the procedure. No severe complications were noted. Transrectal ultrasonography is useful for accurately placing the MEMOKATH stent, as it provides more objective and detailed anatomical findings than fluoroscopy.
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