Shin-ichi Hisasue's research while affiliated with Juntendo University and other places

Hereditary leiomyomatosis and renal cell cancer is a rare genetic disorder characterized by cutaneous and uterine leiomyomatosis, and an aggressive type 2 papillary renal cell carcinoma. The disease is caused by a germline mutation in the fumarate hydratase gene. We report a familial hereditary leiomyomatosis and renal cell cancer in two siblings. A 34‐year‐old woman underwent nephrectomy for treatment of a renal cell carcinoma. The patient's sister had been diagnosed with renal cell carcinoma at 28 years‐of‐age and died of the disease. Neither sister had apparent skin tumors. Histopathology of the renal cell carcinomas of the siblings showed tubulocystic and papillary architectures with high nuclear grades. Immunostaining showed no fumarate hydratase expression in either tumor. Genomic DNA sequencing of the patient showed a germline mutation in the fumarate hydratase gene (c.675delT). Although there is no epidemiological information on Asian hereditary leiomyomatosis and renal cell cancer, physicians should be aware that typical cutaneous leiomyomatosis might not always be present in patients with hereditary leiomyomatosis and renal cell cancer.

The management recommendation for both acquired premature ejaculation (APE) and lifelong PE (LPE) are similar, such as a behavioral/psychotherapy, a pharmacotherapy and a combination of these treatments. For the drug treatment for PE, gold standard is selective serotonin reuptake inhibitors (SSRIs) including dapoxetine or paroxetine. The drug treatment for PE is still developing and some new promising therapeutic options have been proposed. Topical anesthetics, tramadol, and alpha-1 blockers will be the next strategies of the drug treatment for PE in the future.

Objectives: As silent myocardial ischemia (SMI) is a strong predictor of early death especially in patients with diabetes mellitus (DM), our study aims to evaluate the relationship between erectile dysfunction (ED) severity and SMI in DM patients using the multidetector computed tomography coro- nary angiography (MDCT-CA), and to identify predicators of SMI. Material and Methods: The study included 20 diabetic patients with ED with no past and/or present cardiac symptoms. Erectile function was evaluated with sexual health inventory for men (SHIM), erection hardness score (EHS), and mean penile circumferential change (MPCC) by Erectometer. MDCT-CA was used for SMI diagnosis. Results: Data was presented as mean ± SD, median (25th-75th interquartile range), or percentage (%) when appropriate. Patients characteristics showed age 61.45 ± 10.7 years, BMI 27.3 ± 6.93 kg/m2, 95% type 2 DM, DM history 6 (4-15) years, 45% hypertension, 30% Dyslipidemia, 55% smoking, HbA1c 7.38 ± 1.21 %, HOMA-insulin resistance 15.55 (6.95- 37.75) mU/ml, HDL-Cholesterol 44.24 ± 9.35 mg/dl, and LDL-Cholesterol 98.67 ± 32.88 mg/dl. Patients Hormonal profile showed total testosterone 5.53 ± 2 nmol/l, free testos- terone 7.75 ± 2.46 pg/ml, and LH 6.1(5.1-7.7) mIU/ml. Erectile evaluation showed ED history 3 (2-7) years, SHIM score 5 (2.5-8.5), EHS 2 (1-2), MPCC 14.5 ± 9.46 mm. MDCT-CA showed coronary artery stenosis in 13/20 (65%) in the form of one-vessel 6/20 (30%), 2-vessels 2/20 (10%), 3-vessels 5/20 (25%) affection. Half of the patients showed 50% vessel lumen obstruction with the left anterior descend- ing coronary artery was the most common affected (55%). Pearson correlation test demonstrated that maximum coronary artery stenosis was positively correlated with age (r = 0.529, p=0.016), and negatively correlated with EHS (r= -0.449, p =0.046). Multivariate analysis using age & EHS parameters showed that age was the only predicator for SMI (p = 0.04). Conclusions: MDCT-CA could be a useful tool to identify SMI in DM patients with ED especially in those with advanced age, and/or sever ED. A controlled clinical trial with a larger patient sample size is needed.

Introduction: Erectile dysfunction (ED) can precede coronary artery disease. In addition, silent myocardial ischemia (SMI) is more common in diabetic patients and is a strong predictor of cardiac events and death. Aim: To evaluate the presence of SMI in patients with diabetes and ED using multidetector computed tomographic coronary angiography (MDCT-CA). Methods: This study evaluated patients with diabetes and ED without any history of cardiac symptoms or signs. Erectile function was evaluated with the Sexual Health Inventory for Men score, erection hardness score (EHS), and maximal penile circumferential change by an erectometer. MDCT-CA was used for the detection of coronary artery stenosis. Main Outcome Measures: Sexual Health Inventory for Men score, EHS, maximal penile circumferential change, and coronary artery stenosis by MDCT-CA. Results: Of 20 patients (mean age = 61.45 ± 10.7 years), MDCT-CA showed coronary artery stenosis in 13 (65%) in the form of one-vessel disease (n = 6, 30%), two-vessel disease (n = 2, 10%), and three-vessel disease (n = 5, 25%). Fifty percent of patients showed at least 50% vessel lumen obstruction of the left anterior descending coronary artery, which was the most commonly affected vessel (55%). Fifteen percent (3 of 20) of patients had greater than 90% stenosis, and two of them underwent an immediate coronary angioplasty with stenting to prevent myocardial infarction. Maximum coronary artery stenosis was positively correlated with age (P = 0.016, r = 0.529) and negatively correlated with EHS (P = .046, r = −0.449). Multivariate regression analysis using age and EHS showed that age was the only independent predictor of SMI (P = .04). Conclusion: MDCT-CA can be a useful tool to identify SMI in diabetic patients with ED, especially in those of advanced age and/or with severe ED.