Toxicity of ethylene glycol monomethyl ether: impact on testicular gene expression

Methoxyacetic acid (MAA), the active biological oxidation product of the industrial solvent ethylene glycol monomethyl ether (EGME), causes acute toxicity in several species including humans. MAA primarily affects tissues with rapidly dividing cells and high rates of energy metabolism, including testes, thymus and the fetus. Testicular toxicity, one of the most prominent consequences of EGME, and MAA, exposure, results from apoptosis of primary spermatocytes and is associated with changes in the expression of various genes and signalling pathways. This review of EGME metabolism and its organ-specific toxicities emphasizes genes and signalling pathways that are modulated by EGME exposure and their relevance to the molecular mechanisms underlying EGME and MAA toxicity. Of particular importance are the genes that code for oxidative stress response factors, protein kinases, and nuclear hormone receptors. Nuclear receptors and protein kinases regulate multiple cellular processes and are critical for signalling events required for spermatogenesis. De-regulation of their activity by EGME or MAA leads to inappropriate signalling in testicular cells. Oxidative stress in spermatocytes exposed to MAA triggers mitochondrial release of cytochrome C, activation of caspases and ultimately apoptosis. Detailed investigation of the molecular responses to MAA exposure may help elucidate the overall impact and extent of toxicity seen following EGME exposure. Finally, given the effects of EGME on multiple genes and signalling pathways in the testis, mixture studies combining EGME, or MAA, with other testicular toxicants may help identify toxicities that are aggravated by EGME exposure.     

ESWL for stone in a retrocaval ureter: A case report

A male patient with retrocaval ureter and right renal calculus is reported. Stone treatment by ESWL was successful and the patient became stone free after 10 weeks.     

The effects of ethylene glycol monomethyl ether on testicular histology in F344 rats

Ethylene glycol monomethyl ether (EGME) has been found to produce testicular atrophy in experimental rodents. The studies that follow were designed to determine the testicular cell type(s) most susceptible to EGME administration. For histologic studies, F344 rats were gavaged with 150 mg/kg/day of EGME 5 days per week, and serially sacrificed. In sections from perfusion-fixed tissue, necrotic changes were observed in some meiotic and premeiotic spermatocytes 24 hours after a single dose. Also, nuclear condensation was seen in occasional early pachytene spermatocytes. These effects were magnified after two doses; there were more necrotic pachytene and meiotic spermatocytes than necrotic stage I pachytene spermatocytes. By day 4, testes from all treated animals were affected; there was a pronounced maturation-depletion effect, seen as the absence of round spermatids from tubules in stages I to III. These effects continued to develop at days 7 and 10, leaving only Sertoli cells, spermatogonia, and late stage spermatids populating the epithelium. Other animals were treated similarly, but subject to efferent duct ligation 16 hours prior to sacrifice. Fluid production, as judged by weight gain in the testes after efferent duct ligation, was unaffected by EGME treatment. Analysis of the fluid collected at the rete testis indicated that there was no treatment-related change in the relative amounts of androgen binding protein. The data indicate that the spermatocyte is the primary target cell for the histologic effects of EGME in the testis of F344 rats.     

Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment: first report of 6 cases

PURPOSE: We report our series of 6 cases of retrocaval ureter that were successfully treated with a laparoscopic approach. MATERIALS AND METHODS: Three men and 3 women with a mean age of 31 years (range 16 to 50) were referred to our department with a diagnosis of retrocaval ureter. One patient had a 12 mm renal pelvic calculus. A transperitoneal laparoscopic approach was used in all cases. The retrocaval segment along with some of the more proximal and distal segments of the ureter was readily mobilized. The distal part of the dilated renal pelvis was transected and the divided distal segment was repositioned to lie anterior to the inferior vena cava. The renal pelvic stone in 1 patient was readily removed at this point. Re-anastomosis was then performed over a Double-J stent placed intraoperatively using 2 rows of running 4-zero polyglactin sutures with intracorporeal knot tying. The stent was removed 4 weeks later. Excretory urography was performed 3 months after the laparoscopic procedure. RESULTS: Mean operative duration was 180 minutes (range 150 to 210). Patients were discharged home at a mean of 4 days (range 3 to 5). Followup excretory urogram 3 months after laparoscopic repair revealed a widely patent anastomosis with considerable improvement in hydronephrosis in all patients. CONCLUSIONS: To our knowledge this is the largest series of laparoscopic repair of retrocaval ureter reported to date. Laparoscopic pyelopyelostomy for retrocaval ureter without excision of the retrocaval segment is associated with an excellent outcome, minimal postoperative morbidity, short hospital stay and highly satisfactory cosmetic results.     

Congenital absence of the vas deferens associated with retrocaval ureter: a case report

Unilateral absence of the vas deferens is frequently associated with ipsilateral anomalies of the urinary tract. A case of congenital absence of the vas deferens on the right side was associated with retrocaval ureter in a 30-year-old male. He was married and sterile for two years. On scrotal exploration, both testicles were normal but the vas deferens and the body and the tail of the epididymis on the right side were absent. The tail of epididymis on the left side was obstructed. Therefore, we performed a vaso-epididymostomy on the left side and anastomosed an artificial spermatocele on the body of the right-sided epididymis. The diagnosis of retrocaval ureter was confirmed by the intravenous pyelography and the retrograde pyelography.     

MRI在下腔静脉后输尿管中的诊断价值

目的总结下腔静脉后输尿管的影像表现,探讨磁共振尿路成像在该病诊断中的价值。方法回顾性分析9例经手术证实的下腔静脉后输尿管的影像表现,所有病例均行常规磁共振尿路成像MRI及MRU检查;9例行腹部超声检查;8例行腹平片(KUB)及静脉肾盂造影(IVP),其中3例加做逆行肾盂输尿管造影(RUP);3例行中下腹部、盆腔CT检查。结果本组9例下腔静脉后输尿管均发生于右侧,其中8例为Ⅰ型(低袢型),右输尿管呈鱼钩形或"S"形改变;1例为Ⅱ型(高袢型),右输尿管呈"倒置J"形。超声准确诊断1例、静脉肾盂造影(IVP)结合逆行肾盂造影(RUP)检查,准确诊断6例。3例CT检查均能准确诊断。常规MR横断T2加权(MRT2WI)结合MRU检查,8例能准确诊断,诊断准确率为89%。结论 MRI对该病的诊断准确率非常高,而且对人体无生物学损害,具有很高的临床实用价值。     

Laparoscopic dismembered pyeloplasty of a retrocaval ureter: case report and review of the literature

A retrocaval ureter is a rare entity that has traditionally been treated with open pyeloplasty techniques. In this paper, we describe the successful performance of a laparoscopic dismembered pyeloplasty for a retrocaval ureter and present important technical points. In reviewing the available literature about this technique, the laparoscopic approach should be considered to be first-line treatment for this anatomic anomaly due to the good track record, quick convalescence, and relative technical ease.     

后腹腔镜下腔静脉后输尿管扩张段离断矫正术病例报道并文献复习

目的 报道后腹腔镜途径治疗下腔静脉后输尿管离断矫正术的初步经验.方法 患者21 岁,男,无任何不适,体检超声检查发现右肾轻度积液、右输尿管上段扩张,静脉肾盂造影(IVU)、逆行插管肾盂造影提示腔静脉后输尿管.患者取左侧卧位,建立后腹膜间隙,常规于肋弓下置三个鞘卡,离断扩张处输尿管后端端无张力吻合.结果 手术经后腹腔镜完成,用时170 min,出血20 ml,术中及术后无并发症发生.结论 后腹腔镜下于扩张处离断输尿管矫正术可以作为下腔静脉后输尿管首选治疗方案.     

Severe mesangiolysis in a patient exposed to glycol ether solvents

Sir, Toxic agents are known causes of mesangiolysis and the bestexamples are Habu snake venom and mitomycin C [1]. We describea patient with mesangiolysis occurring during a period of glycolether exposure. Case. A 53-year-old man complained of peripheral paraesthesia.His history consisted of an 130/85     

Anterior urethral diverticular stones and retrocaval ureter in male: a case report and review of literature in Japan]

A case of diverticular stones in the male anterior urethra with retrocaval ureter is reported. A 26-year-old man visited our hospital for examination, who had experienced spontaneous stone discharge a few days earlier. Computed tomographic (CT) scan with ureteral catheterization and urethrography revealed a retrocaval ureter and urethral diverticular stones. Resection of urethral diverticulum with 7 stones and right ureteroplasty were performed. The urethrography and drip infusion pyelography (DIP) 9 months after operation showed no abnormal findings. The largest stone was 28 x 22 x 20 mm in size and 20 g in weight. The main components were ammonium dihydrogen-urate (70%), carbonate apatite and struvite. Histological feature of the epithelium of the urethral diverticulum indicated normal skin with hairs. Pathological diagnosis was para-urethral dermoid cyst. Our case is the 67th case of the male urethral diverticular stones and the first case of those with retrocaval ureter in Japan.     

Antioxidants: a possible role in kidney protection

Oxidative stress contributes to the pathophysiology of kidney injury. Beneficial renal effects of some medications, such as angiotensin-converting enzyme inhibitors, angiotensin II type 1 receptor antagonists, calcium channel blockers, beta-blockers and lipid lowering agents depend at least partially on the ability to alleviate oxidative stress. The administration of various natural or synthetic antioxidants has been shown to be of benefit in prevention and attenuation of renal scaring in numerous animal models of kidney diseases. These include vitamins, N-acetylcysteine, alpha-lipoic acid, melatonin, dietary flavonoids and phytoestrogens, and many others. Human studies are limited in this regard. Under certain conditions, surprisingly, the antioxidant supplements may exhibit pro-oxidant properties and even worsen renal damage. To date, the evidence is insufficient to recommend antioxidant supplements in patients with kidney disease. Prospective, controlled clinical trials on safety and effectiveness of different therapeutic antioxidant strategies are indispensable.     

Renal dysplasia with a single vaginal ectopic ureter: the role of computerized tomography

Renal dysplasia with a single vaginal ectopic ureter is relatively common in Japan. We report 2 cases in which delayed enhanced computerized tomography (1.5 hours later) contributed in detecting a dysplastic kidney that had been nonfunctioning on excretory urography. We believe that computerized tomography is a useful technique for the diagnosis of renal dysplasia with a single vaginal ectopic ureter.