Search

Bacteremia can easily become severe, and it is necessary to start appropriate treatment quickly before it progresses to sepsis. In this study, we investigated a method using antibiotic discs to quickly report antibiotic resistance information for bacteremia caused by gramnegative bacilli, such as Enterobacterales , which require careful selection of appropriate antibiotics due to their tendency to cause severe illness. In cases of bacteremia caused by ESBL and AmpC-producing bacteria, reports of suspected antibiotic resistance mechanisms were made within a few hours after disk placement, allowing for the rapid modification of antimicrobial therapy, thereby contributing to the treatment. This method is considered highly beneficial as it does not require special equipment and is a cost-effective approach. However, as this method is different from the conventional disk diffusion method, and since some cases showed susceptible inhibition zone diameters for antibiotics considered to have intrinsic resistance, further investigation is necessary for its use in determining susceptibility.

An 83-year-old Japanese man who underwent cholecystectomy for cholecystolithiasis 17 years ago visited our hospital owing to epigastric pain. He was initially diagnosed with choledocholithiasis and acute cholangitis following white blood cell, C-reactive protein, total bilirubin, alkaline phosphatase, and γ-glutamyltranspeptidase level elevations along with common bile duct stones on computed tomography (CT). Moreover, CT, magnetic resonance imaging, endoscopic retrograde cholangiography (ERC), and endoscopic ultrasonography (EUS) also revealed a 2-cm-diameter mass arising from the remnant cystic duct. The cytology of the bile at the time of ERC was not conclusive. However, EUS-assisted fine needle aspiration (EUS-FNA) of the mass confirmed the diagnosis of adenocarcinoma of the remnant cystic duct. The patient underwent extrahepatic bile duct resection. Cystic duct carcinoma following cholecystectomy is rare. We report a case diagnosed by EUS-FNA.

A 67-year-old man was diagnosed with ulcerative colitis one year ago. Remission was induced via the oral administration of prednisolone and azathioprine;prednisolone was gradually reduced and discontinued. He maintained remission with azathioprine but developed fever and general malaise and visited the Kagawa Prefectural Central Hospital. Chest radiography and a urinary antigen test revealed Legionella pneumonia. His symptoms reduced immediately after the initiation of levofloxacin. Azathioprine suppresses cellular immunity and may increase the risk of Legionella pneumonia.

A ring-shaped ulcer was observed in the ileum of a 70-year-old male patient with capsule endoscopy of the small intestine performed for detailed investigation of black stools and iron deficiency anemia. Non-steroidal anti-inflammatory drugs (NSAIDs) use in patch form was considered as the etiology. The NSAIDs patches were discontinued, and protective therapy for small intestinal mucosa was initiated. The anemia improved;however, ileus originating from the site of the ulcer required surgical resection. The resected specimen showed no specific pathological findings. Based on the clinical findings, the patient was diagnosed with NSAIDs-induced small intestinal ulcer. The use of NSAIDs patches should be considered as a potential cause of injury to gastrointestinal mucosa.

General anesthesia combined with epidural anesthesia for thoracotomy due to spontaneous pneumothorax was given to a pregnant woman at 21st week of gestation. She was premedicated intravenously with famotidine 20 mg and metoclopramide 10 mg. Mepivacaine 1% was administered through a thoracic epidural catheter. General anesthesia was induced by thiamylal 225 mg, vecuronium 8 mg and fentanyl 100 mcg, and maintained by sevoflurane, vecuronium and fentanyl. Endobronchial intubation with a 35Fr Bronchocath double-lumen tube was successful and one-lung ventilation was commenced to maintain the end-expiratory CO2 pressure at 30 to 35 mmHg with Sp(O2) remaining 100%. Ephedrine 16mg (in 4mg increments) was required to maintain systolic blood pressure above 100 mmHg. After the surgery, ropivacaine 0.2% was administered through the catheter. There were no clinical signs of fetal distress during the perioperative period. Postoperative pregnancy and delivery were uneventful. We succeeded in the anesthetic management by avoiding hypoxia, hypercapnia, hypocapnia and hypotension during the surgery.

The effects of tacrolimus ointment on immediate, late and delayed-type cutaneous allergic reactions and normal skin thickness were investigated in mice and compared with those of steroid ointments. Tacrolimus ointment had no effect on ear edema in the immediate phase of the biphasic reaction and did not inhibit passive cutaneous anaphylaxis, but in the late phase of the biphasic reaction, it inhibited the ear edema. It also showed a clear inhibitory effect on the delayed-type reaction. These evidence suggest that the clinical effect of tacrolimus ointment against atopic dermatitis (AD) may be mainly due to its inhibitory action on late and delayed-type reactions. The steroid ointments inhibited all the reactions mentioned above, and the effects were more potent than those of tacrolimus. Moreover, they also decreased the normal ear thickness, suggesting that the inhibitory effect of the steroid ointments was partially due to skin atrophic action. The same ointments applied to the ears during the induction phase showed an enhancement of delayed-type reaction at the effector phase. Tacrolimus ointment did not show such a rebound effect or skin atrophy. Thus, tacrolimus ointment was expected to be more useful than the steroids for the treatment of AD.

We performed phase III clinical study of AMI-25 (Superparamagnetic iron oxide) for hepatic tumors in 163 cases at the 17 institutions in Japan. In overall evaluation, 141/159 cases (88.7%) were evaluated "useful" or "very useful" for clinical usefulness. For efficacy including the signal to noise ratio (S/N) of liver and the tumor-liver contrast to noise ratio (C/N), 89.6% of hepatocellular carcinomas and 95.0% of metastatic liver cancers were evaluated "effective" or "very effective", respectively. The mild adverse reactions were shown in 10 cases (6.1%), but they disappeared within 25 minutes. The serum iron and ferritin increased and the unsaturated iron binding capacity (UIBC) decreased, but they were showing a tendency to go back to their normal ranges. The AMI-25 (10 mumoles Fe/kg) was proved to be useful and safe contrast agent for the liver tumors in MRI.

The monoclonal antibody CEA 102 against carcinoembryonic antigen was produced by immunization with purified CEA, and used as a radiotracer for the imaging of colorectal cancer. CEA102 was labeled with 131I by the chloramine-T or the Iodogen method, and administered i.v. to 20 patients with liver metastases, local recurrences, and/or primary tumors. Planar scintigraphy was performed during 5 or 6 postinfusion days. Hypersensitivity reactions such as fever and chill occurred in 4 patients, but no side effects were noted after endotoxin was excluded. Overall sensitivity was 71.4% (primary tumor 4/4, liver metastasis 5/6, lymph node metastasis 1/1, local recurrence 5/10), and no false positive was observed. In the cases of local recurrences, this method was useful to distinguish postoperative fibrosis from local recurrence. These results revealed that radiolabeled CEA102 has a great potential in qualitative diagnosis of colorectal cancer.

The potential usefulness of in vivo 19F NMR spectroscopy for the monitoring of flomoxef sodium (FMOX) kinetics was evaluated. In the experimental study using phantom the minimum concentration of FMOX of which signals could be monitored with 19F NMR spectroscopy was 16 micrograms/ml. In patients with intravenous bolus injection and drip infusion of FMOX (2 g/100 ml), signals from normal heart, liver, and kidney were clearly monitored with 19F NMR spectroscopy. In normal lung any signal was not detected, but in a lung with a cancer associated massive atelectasis the monitoring of signals was possible with 19F NMR spectroscopy in both intravenous and intraarterial injections. Monitoring of FMOX kinetics with in vivo 19F NMR spectroscopy will be useful in clinical applications.

The biological effects of a static gradient magnetic field and its combined effects with ionizing radiation on FM3A cultured cells were investigated. The magnetic strength of the center of the field was 5.8 x 10(-2) T esla, the mean gradient of the magnetic filed was 0.6 T esla/m. The magnetic field influenced cell cycle. The relative amount of cultured cells in G1 phase decreased for eight hours after exposure. The growth rate of the cells was slowed by about 5%. Following exposure to the magnetic field, the survival rate of cells decreased to about 20% less than that of the non-exposed control. The combined effect of 60Co irradiation with exposure to the magnetic field showed a greater effect than a simple additive one. The combined effect was influenced by the interval between 60Co irradiation and exposure to the magnetic field. The biological effects of the magnetic field may be related to age-dependent cellular damage in the cell cycle, blockage of cell progression in the cell cycle, and increased repair from radiation damage.

Thirty-three joints in 31 patients of Kienböck disease were evaluated with three-phase bone scintigraphy. Follow-up studies were performed in 19 cases of them. The patients with increased ulnar blood flow on arterial phase and ample perfusion on venous phase in angiograms showed good clinical prognosis. This ample ulnar blood flow and perfusion might be essential for the recovery of this disease. Although staging was possible using static images alone, blood pool images provided more information about the present condition of lesions, such as hyperemic state and remodeling reactions. Blood pool image was indispensable for staging and analyzing lesions and evaluating post-operative course. Increased lunate perfusion in venous phase of angiograms and localized lunate uptake in blood pool images were the favorable signs, which were shown in most cases with good prognosis. It is concluded that three-phase bone scintigraphy gives useful informations for evaluating Kienböck disease which can not be obtained by conventional bone scintigraphy.

A 25-year-old Japanese female was admitted to the Department of Surgery in Kyushu Koseinenkin Hospital because of serious right hypochondralgia. Gastrofiberscopy, abdominal ultrasonography, intravenous pyelography and irrigoscopy did not reveal the origin of the pain, and she was introduced to the Department of Internal Medicine. Because enzyme immunoassay of the uterine cervical specimen in the Department of Urology showed positive chlamydial antigen, we suspected her of perihepatitis induced by Chlamydia trachomatis (Fitz-Hugh-Curtis syndrome). Laparoscopy revealed typical violin string adhesions between the anterior surface of the liver and the corresponding parietal peritoneum, and the diagnosis was confirmed. After an administration of Ofloxacin was started, the symptom disappeared completely. It is considered to be important to remember this syndrome when examining a young women with right hypochondralgia.

Transcatheter arterial embolization using a coaxial microcatheter and micro-coil was performed in eight patients with vascular lesions; one each with aneurysm of the basilar artery, cerebellar artery, and pancreatic artery, pseudoaneurysm of the common hepatic artery, gastroduodenal artery, and gluteal artery, carotid-cavernous fistula, and thoracic paraspinal arteriovenous malformation. Complete occlusion was achieved in five patients with aneurysm and pseudoaneurysm by occluding the aneurysmal cavity and/or the orifice. A patient with recurrent carotid-cavernous fistula was also completely embolized. A case of basilar artery aneurysm resulted in partial occlusion because the posterior cerebral artery originated from the aneurysm. The unsatisfactory result in a case of paraspinal AVM was due to its wide extension with multiple feeding arteries. No apparent complication was seen. In conclusion, super-selective arterial embolization therapy with coaxial microcatheter and micro-coils was found to be a useful method for vascular lesions that would have been technically difficult to embolize with the standard catheter and coils.

201Tl myocardial SPECT findings in infantile ventricular tachycardia (VT) were examined. The subjects were 4 cases of infantile VT subjected exercise-loading 201Tl scintigraphy in 1990. These cases (3 males and 1 female) were aged 11-14 years, being persistent and non-persistent type VT (2 cases each). Echocardiography revealed no abnormal findings in these 4 cases. Exercise-loading was performed by means of sitting ergometer. ECG revealed sinus arrhythmia except for one case which throughout its course of treatment, had already been presenting ventricular extrasystole from before the exercise-loading. Myocardial SPECT revealed persistent defects (anteroseptal wall defects in three case). The above suggests that 201Tl myocardial SPECT enables us to search for etiology of VT, prognosis and the like.

In order to improve cancer imaging with radiolabeled antibodies, three factors appeared to be of particular importance: (1) The selection of the most favorable monoclonal antibody directed to tumor-associated antigen. (2) The use of F(ab')2 or Fab fragments. (3) Selection of the most convenient isotope. Monoclonal antibody CEA 102 was produced by immunization by purified CEA, and its F(ab')2 fragments were compared with whole IgG as a radiotracer for radioimmunodetection of the colorectal cancer. Fragments were eliminated from the circulation twice as fast as whole IgG, and tumor-to-background ratio was achieved more than 1 at 2-3 days with F(ab')2, but 6-7 days with whole IgG in tumor bearing nude mice. In clinical study, F(ab')2 demonstrated clear image on the 1 at day after injection, whereas achievement of the image was possible on the 3rd day in whole IgG. These results indicated that fragments are preferred over whole IgG. Therefore fragments make it possible to preclude dual isotope subtraction methods, and omit the long delays before imaging. They also make it possible to use short half life radionuclides with excellent photon properties, such as 123I and 99mTc.

Skin doses of 100 patients who were treated with high energy ionizing irradiation during conventional irradiation therapy were measured by thermoluminescence dosimeter (TLD). In 87 of the 100 patients, acute hyperemic change of the skin (erythema) of the irradiated region was observed. In the other 13 patients, alopecia of the scalp was observed. The following conclusions were reached. 1) The time-dose relationship was linear when erythema tolerance was used as an index, but not when alopecia was used. 2) The tolerance dose for erythema was lower than previously reported. The slope of the isoeffect curve on the log-log plot of total absorbed skin dose against total number of days after the first irradiation was 0.68 when erythema was used as an index. This number is larger than previously reported results. We considered that erythema is significantly influenced by fraction size and that hyperfractionation is a promising method of irradiation, especially in Japan. 3) Combined use of chemotherapeutic agents, such as 5-Fu, accelerated erythema. The slope of combined treatment was 0.86. Observing acute hyperemic change of skin is considered to be a useful method of investigating the combined effects of chemotherapeutic agents on irradiation.

Mechanical arc scanning is widely used for breast sonography in Japan. The authors have used three different kinds of devices over the past seven years. The diagnostic accuracy was compared among three groups of patients with pathologically confirmed breast masses. In group A, 309 cases (77 carcinomas) were evaluated with a 10 MHz contact compound scanner, and the sensitivity, specificity and accuracy rates were 77.9%, 97.8% and 92.9%, respectively. In group B, 306 cases (56 carcinomas) were evaluated with a 5 or 7.5 MHz mechanical arc scanner, and the sensitivity, specificity and accuracy rates were 89.3%, 84.8% and 85.6%, respectively. In group C, 296 cases (71 carcinomas) were evaluated with a 7.5 MHz real time scanner, and the sensitivity, specificity and accuracy rates were 95.8%, 92.4% and 93.2%, respectively. In cases with T1 breast cancer, the methods had sensitivities of 60.0%, 85.7% and 94.5%, respectively. The sensitivity of the real-time scanner was not significantly different from that of the mechanical arc scanner. In conclusion, the hand-held real-time scanner with high-frequency transducer is a simple, useful device with high diagnostic accuracy for breast examination and can be used as a substitute for the mechanical arc scanner.

A new method is proposed for external stereotactic and three-dimensional irradiation for a small target in the skull. In this method, we use a special long tube collimator, helmet-type shell (guiding rods are attached to the shell using the CT-stereotactic apparatus) and 10 MV linear accelerator. The patient's head is fixed conservatively by the helmet-type shell. In the phantom experiment, the 90% isodose area was 10 mm in diameter, and the error between the geometrical center of the target and the irradiated center was 2 mm.

We have designed and developed a new database system to facilitate automatic feedback of the content of radiology reports to radiologists. The prototype of this database system has been implemented in the RGSS-IDJ, a developmental computer system that applies artificial intelligence methods to a reporting system. This prototype system was constructed to test the feasibility of overcoming the limitations of conventional database systems. The new database system is based on our semantic model for radiology reports and is able to treat data with unnormalized relations. Operations specific to our database system include the ability to acquire information about a set of reports that contains any semantic expression included in the lexicon and the ability to obtain the expressions that belong to a set of several semantic expressions in the reports. Thus, our new database system will offer a more powerful tool for analyzing the content of reports than conventional database systems.

A series of 64 patients underwent surgical treatment for chronic subdural hematomas between 1980 and 1989. The procedure consisted of a single burr-hole, irrigation of the hematoma without subdural drainage and lumbar intrathecal injection of Ringer's solution. Irrigation was carried out until the washing was clear and the injection was continued until the brain was in contact with the edge of the burr-hole. Excellent outcome was achieved in 53 patients (82.8% of the total). Two of the patients died, thus making a 3.1% mortality rate. Such complications as tension pneumocephalus and intracerebral hematoma were not observed and no patient had a recurrence.

Transcatheter arterial embolization therapy was performed in fifteen patients with hypervascular metastatic bone and soft-tissue tumors (7 from renal carcinoma, 5 from hepatocellular carcinoma, and one each from breast, thyroid, and cholangiocarcinoma). Sites of metastasis were spine (7), pelvis (5), skull (2), paraspine (2), chest wall (1), and thigh (1). Five patients had not responded to previous radiation therapy and hyperthermia. Embolization of feeding arteries was performed superselectively with long tapered catheters or coaxial microcatheters. Emulsion of Lipiodol and anticancer agent, polyvinyl alcohol sponge, gelatin sponge, and microcoils were used as embolic materials in various combinations. Relief of pain was experienced in 14 of 15 patients. Two patients were operated following embolization with minimal blood loss. Change in tumor size was evaluated by CT or MRI in ten patients. Reduction of tumor size were more than 50% in five patients, from 25% to 50% in two, and no change in three patients. Especially, patients embolized with microcatheter and microcoils showed excellent long-term results. No serious complications were seen. In conclusion, superselective arterial embolization therapy with coaxial microcatheter and microcoils was proved to be an useful treatment for hypervascular metastatic bone and soft-tissue tumors.

In this paper we attempted MR visualization of the vestibular aqueduct (VA) with a surface coil. Sagittal plane was most preferable from the result of preliminary study using a dry temporal bone. In all of ten normal volunteers, VAs were visualized well. In none of them, proton-density weighted spin-echo (SE) images were inferior to both T1- and T2-weighted SE image. In four of eight patients with Menière's disease, VAs were not visualized due to obstruction of VA, although in all of ten non-Menière's patients with hearing loss or vertigo, VAs were well visualized. Although further investigation is needed, MR imaging of VA including both its content and surrounding bony structure would give important information to manage the patients with either Menière's disease or other disorders of internal ears.

Short-term treatment (3 minutes) with low intensity (1.8 w/cm2) ultrasound was applied to human tumors in combined treatment with ionizing radiation. Tumor regression was observed with the dose below TDF (time dose fractionation) 40, and 50% reduction in tumor masses was observed at doses with TDF 45 to 62, and the mean dose was TDF 52. Complete remission of tumor masses was recognized with doses of TDF 62 to 113 in 9 of 10 treated lesions. Five cases, with multiple lesions, were treated with controlled ionizing radiation without ultrasound. Fifty percent reduction in tumor masses was observed with doses of TDF 74 to 113, and the mean dose was TDF 86. Complete remission of tumor mass was not observed. Radioenhancement ratio by ultrasound was 1.6 for 50% tumor reduction. Skin temperature was elevated to about 3 degrees C as measured by thermography, but intradermal temperature was not apparently elevated. Ultrasound potentiates the effects of localized radiotherapy not due to hyperthermia but to the other factors.

We developed a new laser beam generator system which can deliver laser beam to multiple terminals in distant clinical therapy rooms. The system possesses the distribution equipment by which Nd-YAG laser power is distributed to 8 output terminals under the computer control. Distributed laser beam is delivered to each distant terminal with clinical informations through the optical fiber. In the fundamental studies, possibility of distant transportation of laser beam (30 m) only with 10% loss of energy and without dangerous heating at the connection parts was shown. There seems to be no disadvantage associated with distribution laser beam. In the clinical study, the system was applied to five patients with the symptoms including hemosputum, esophageal stenosis, hemorrhage, lip ulcer and pain. Clinical usefulness of the system was proved. The advantages of the system are as follows: 1. Benefit of cost reduction due to multiple use of single laser source. 2. No necessity of transport of the equipment. 3. No requirement of a wide space to install the equipment in the distant room. 4. Efficient management and maintenance of the system by centralization. Further improvements, e.g., simultaneous use at multiple terminals and elongation of transportation up to 340 m, make the system more useful for clinical application.

67Ga scintigraphy was performed in 865 patients, and in 1078 examinations. 67Ga accumulation was evaluated retrospectively for asymmetric accumulation in the shoulders. Approximately 50% of patients showed no asymmetric distribution of 67Ga in the shoulders. About 40% of patients showed increased accumulation in the right side and about 10% of patients showed increased accumulation in the left side. A change of 67Ga distribution in the shoulder joints was recognized in about 30% of patients during the follow-up study. Reasons for asymmetric distribution of 67Ga in the shoulders were considered to be due to bone metastasis, changes of local blood flow, edema, irradiation, muscle atrophy after cerebral paralysis, and operation. 67Ga scintigraphy showed a broader range and more prominent accumulation in the soft tissues around the shoulder joint than 99mTc-MDP scintigraphy. The accumulation of 99mTc-MDP was recognized to be in the center of the region of 67Ga accumulation. 99mTc-MDP scintigraphy showed more prominently increased accumulation than 67Ga scintigraphy in patients with osseous lesions. Similar factors appeared to have had an influence on the abnormal accumulation of 67Ga and 99mTc-MDP around the shoulder joint.

During the past 4 years, three-phase bone scintigraphy using 99mTc-MDP has been studied in 68 patients suffering from hemi-lateral hip-joint disorders. We were impressed on abnormal uptake of the shaft of femur on the involved side. 99mTc-MDP uptake in the shaft of femur is compared with between involved leg and normal leg of 68 cases with hemi-lateral hip-joint disorders (76 examinations). We excluded cases of osteomyelitis, cases of malignant tumor, and post-operative cases. In early images, the 99mTc-MDP uptake is not always increased in involved side. But in delayed images, there are no patients whose normal side's 99mTc-MDP uptake is increased. The 99mTc-MDP uptake in early image is not related only with blood flow of the thigh but with the amount of soft tissue of the thigh. And the 99mTc-MDP uptake in delayed image is related with disuse osteoporosis.

The authors present a case of a woman with intramedullary spinal cord metastasis from adenocarcinoma of the corpus uteri. Such a case was not able to be found in the literature. A 54 year-old woman complained of right upper extremity weakness and headache. CT scan showed abnormality, and removal of a brain tumor was performed. After that, total hysterectomy, retroperitoneal lymphadenectomy and chemotherapy was carried out. Three months later, she suddenly experienced bilateral weakness in her lower extremities. After a few days she was unable to walk. Gd-DTPA enhanced MRI showed an abnormal mass at the upper part of the conus medullaris. Total removal of the intramedullary tumor was performed and adenocarcinoma was diagnosed histopathologically.

We evaluated the lung perfusion scintigraphic findings of endobronchial foreign bodies in four children. We could detect the bronchial stenosis due to foreign bodies by lung perfusion scintigraphy more easily than plain chest radiograph and predict the location at lobar bronchi level according to the hypoperfusion area. We guessed that the scintigraphic abnormal finding after plain chest radiographic normalization reflect bronchial inflammatory change after foreign body removal and so it is very important to perform the follow up scintigraphic examination.

Thallium-201 myocardial single photon emission computed tomography (myocardial SPECT) has been believed likely to miss lesions or false lesions in the inferior wall of the left ventricle and septum in the vicinity of the basis of the heart. In 35 patients having undergone both coronary arterio-angiography and contrast left ventriculography, technetium-99m cardiac pool SPECT synchronized with electrocardiography (cardiac pool SPECT) and myocardial SPECT were performed simultaneously. Both cinematographic and phase techniques were used for the cardiac pool SPECT. Visual and Bull's eye techniques were used for the myocardial SPECT. The rate of correct diagnoses made by myocardial SPECT was compared by site with that by cardiac pool SPECT. With the inferior wall of the left ventricle of diagnoses made by cinematographic and phase techniques of cardiac pool SPECT, 97.0% each was correct. The rates of accurate diagnoses made by visual and Bull's eye techniques of myocardial SPECT were 97.0 and 93.9%, respectively. The rate at which at least one of the SPECT methods was correct was 97.1%. With the septum, the corresponding rates of accurate diagnoses were 97.1, 94.3, 90.0, and 90.9%, with rate of 94.3% at least one of these two methods made correct diagnoses. In conclusion, for diagnosing infarcts of the septal wall of the basis, the cardiac pool SPECT is more accurate than myocardial SPECT.

Retrograde transurethral balloon dilatation of urethral stenosis was performed in five patients: four patients with benign prostatic hypertrophy and one with urethral stricture following open prostatectomy. Significant resolution of symptoms of dysuria was seen in four patients throughout the follow-up period of 12 to 18 months. A balloon diameter of 25 mm was considered to be necessary for prostatic hypertrophy. The unsatisfactory result in one patient with prostatic hypertrophy was believed to be caused by incomplete dilation due to a small balloon diameter. Mild transient hematuria was seen in all cases. Only one patient with postoperative urethral stricture complained of pain during balloon inflation, while other patients with prostatic hypertrophy did not complain of any apparent pain. We conclude that this technique is a safe and effective method of treatment for prostatic hypertrophy and other urethral strictures.