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A 42-year-oldman visited our hospital because of gradually worsening penile swelling over 3 weeks. A hard mass on the glans was palpated; however, we were unable to observe it due to severe phimosis. Magnetic resonance imaging of the pelvis revealed enlargement of glans and swelling of bilateral inguinal lymph nodes as both showed a low signal intensity on T2-weightedimaging, a high signal intensity on diffusion-weighted imaging, and a low signal intensity on the apparent diffusion coefficient map. Fluorine- 18-deoxyglucose (FDG) positron emission tomography showed FDG uptake at the external iliac, common iliac, obturator, and cervical lymph nodes besides the glans and inguinal lymph nodes. Although his serum squamous cell carcinoma antigen level was within the normal range, his soluble interleukin-2 receptor concentration was elevated to 2,290 U/ml. Therefore, we diagnosed these lesions as penile cancer with multiple lymph node metastases, with a possible differential diagnosis of malignant lymphoma. We planned a penile needle biopsy; however, the rapid plasma reagin test and treponema pallidum hemagglutination test, which were performed during the preoperative examination, were positive and led to a diagnosis of secondary syphilis. The patient was treated with oral amoxicillin at 1,500 mg/day for 8 weeks. The penile and lymph node swelling subsided after starting medication.

A 46-year-old woman was referred to our hospital with a left-sided renal tumor pointed out by ultrasonography at the time of a medical checkup．Computed tomography revealed a mass measuring 88×77×68 mm on the upper pole of the left kidney. She was diagnosed with cT2aN0M0 clear cell renal cell carcinoma. Laparoscopic left nephrectomy was performed uneventfully. Histopathological diagnosis was clear cell renal cell carcinoma, G2, v1, pT2. Four months after surgery, lung metastases appeared, and systemic therapy was given sequentially as follows ; sunitinib for 2 months, nivolumab for 8 months, axitinib for 17 months, and pazopanib for 2 months．However, metastases progressed, and a re-administration of nivolumab was planned. The nivolumab re-treatment resulted in a marked reduction in multiple lung metastases despite the previous failure by nivolumab treatment. There are few reports on the therapeutic effect of re-administration of nivolumab. We report a case of successful treatment by re-administration of nivolumab.

Hemolytic uremic syndrome (HUS) and acute encephalopathy caused by enterohemorrhagic Escherichia coli infection occur commonly in children, whereas adult-onset disease is rare. Here we report the case of a 24-year-old woman who developed acute encephalopathy and recovered without sequelae. She initially developed abdominal pain and diarrhea. On day 6, O-157 Shiga toxin was detected in her stool and she developed HUS. On day 11, acute encephalopathy developed and she required artificial ventilation. She was treated with steroid pulse therapy and plasma exchange (PE) and then discharged on day 53 without any sequelae. Globotriaosylceramide, a Shiga toxin receptor, is more frequently present on the cellular membranes of women than on those of men. Therefore, it is conceivable that adult women are at a higher risk of developing acute encephalopathy than men. Steroid pulse therapy and PE may effectively treat acute encephalopathy by reducing inflammatory cytokine levels in the blood; therefore, these treatments should be proactively considered.

Gestational variations in maternal beta-endorphin (beta-end) secretion were investigated by simultaneous measurements of plasma and urinary immunoreactive beta-endorphin (ir-beta-end). Urinary ir-beta-end was extracted by using a Sep-Pak C18 column and was found to be stable for at least 24 hours at room temperature. Plasma and urine (2 hour collection) samples were obtained from 41 pregnant women and 7 non-pregnant women. Almost parallel increases in plasma and urinary ir-beta-end were observed during the course of pregnancy and there was a good correlation between them. Compared with non-pregnant values, significant increases (p less than 0.001) were observed after 36 weeks of gestation. We also studied chromatographic patterns of urinary extracts of non-pregnant and pregnant women. Both of them consist of 4 peaks and resemble each other. They were essentially similar to those of plasma extracts except for the third peak which appeared between the elution position of beta-lipotropin (beta-LPH) and beta-end. In conclusion, maternal beta-end secretions increase in late gestation not only in plasma but also in urine.

In order to investigate the steroidogenesis of dysfunctional ovaries, adrenal suppression and ovarian stimulation tests were performed on 32 patients with ovulatory defect and 3 volunteers with normal menstrual cycles. The protocol of this study was as follows; 3 mg of dexamethasone (DXM) was given daily for 11 days. From 5th day of DXM, 225 IU of human menopausal gonadotropin (hMG) was injected for 3 days, followed by 5,000 IU of human chorionic gonadotropin (hCG). Serum estrone (E1), estradiol (E2), androstenedione (A), dehydroepiandrosterone (DHA), testosterone (T) and dihydrotestosterone (DHT) were measured by radioimmunoassay. In the patients with polycystic ovaries (PCO) which was confirmed under laparotomy and biopsy, serum E2 levels were markedly elevated by hMG stimulation. The E1 levels were similarly elevated by hMG stimulation and increased further by hCG stimulation. The A levels were significantly high (p less than 0.05), and increased remarkably by hCG. The T levels were very high. And they decreased to 2/3 of the basal level following DXM administration, and they increased again by hCG stimulation. Similar secretion patterns of these steroids in PCO patients were also seen in controls and in some patients with moderately atrophic ovaries (MA). THe secretion pattern of DHA suggested that DHA was also secreted from the PCO, normal ovary and MA ovary. From these results it is presumed that excessive production of androgens is not specific in PCO, but it is the result of continuous intrinsic LH stimulation.

Sixty-seven and 109 sonographic endometrial images obtained from 67 infertile patients and 5 healthy volunteers with normal ovulatory cycles, respectively, were investigated with regard to serum estradiol (E2) and progesterone (P) levels. The ultrasound devices used were sector electronic scanners (3.5 MHz). 1) Endometrial images were able to be classified into four pattern types, according to the criteria reported by Sakamoto (1985), using a gray-scale contact compound scan. Pattern 1: linear cavity echo, pattern 2: thick hypoechoic endometrium surrounded by thin border echo, pattern 3: thickened border echo, pattern 4: entire echogenic endometrium. 2) Both E2 and P levels were low in pattern 1. The E2 level was significantly higher in pattern 2 than in pattern 1 (p less than 0.01), indicating pattern 2 reflects E2 surges prior to ovulation. The P level was high in pattern 3; and in pattern 4, it was significantly higher than in patterns 1 and 2 (p less than 0.01), indicating that patterns 3 and 4 are in the early and mid-luteal phase, respectively. 3) Sonograms obtained from 12 cases with suspicious luteal phase defects showed an abnormal pattern in the mid-luteal phase. These results indicate that the sonographic endometrial images reflect respective ovarian hormone levels.

A new classification system of endometriosis proposed by the American Fertility Society (AFS classification) was utilized to categorize patients with endometriosis after surgical treatment and the following results were obtained. 1. AFS classification system was useful to categorize patients with endometriosis, because of a simple and objective point system. 2. There were discrepancies in categorized patients between AFS system and a system proposed by Acosta et al. (Acosta's system). One-third of patients categorized as "Severe" by Acosta's system was classified to be "Moderate" by AFS system. These discrepancies occurred when lesion of endometriosis was just restricted within ovaries. 3. Conception was reduced once ovaries were involved and fecundability rate was significantly reduced if ovarian endometrioma was greater than 3cm in diameter. 4. Acosta's system revealed differences among fecundability rate among the different categories, however, AFS system could not demonstrate a direct correlation between the categories of endometriosis and fecundability rate.