[Prostatic endometrioid carcinoma: a case report].

An 89-year-old man presented with urinary retention. Digital rectal examination was benign despite elevated serum prostate-specific antigen (PSA) level. Suprapubic prostatectomy was performed under the diagnosis of benign prostatic hyperplasia. Histopathological diagnosis was endometrioid carcinoma showing positive immunohistochemical staining for PSA. Postoperatively, estrogen was administered for 9 months. After 37 months, serum PSA level began to increase and a palpable nodule was detected on digital rectal examination. Biopsy showed coexistence of endometrioid carcinoma and acinar adenocarcinoma. Hormonal treatment was resumed and the disease has been well controlled for 65 months postoperatively.

Benign renal tumors detected among healthy adults by abdominal ultrasonography.

Renal ultrasonography was performed on 17,941 healthy adults without any signs suggestive of urinary tract malignancies. Diffusely hyperechoic renal masses indicative of angiomyolipoma were found in 41 (0.23%) of them and those with echogenic image suggestive of renal cell carcinoma in 45 (0.25%). Final diagnosis of the former group included 24 angiomyolipoma, 1 renal cell carcinoma, 9 calculus and 7 normal variants. The latter group included 19 renal cell carcinomas, 1 leiomyoma, 1 cavernous hemangioma and 24 normal variants or cysts. In total, 24 (0.13%) angiomyolipomas, 20 (0.11%) renal cell carcinomas, 1 leiomyoma, and 1 cavernous hemangioma were discovered. The results indicate that asymptomatic benign renal tumors mainly consisting of angiomyolipoma are not uncommon.

[Asymptomatic multilocular cystic renal cell carcinoma].

From January 1982 to December 1989, we experienced seven multilocular cystic renal cell carcinomas (MLCRCCs) in 36 asymptomatic renal cancers incidentally diagnosed, and none in 23 symptomatic renal cancers (p less than 0.05). No multiocular cystic nephromas (MLCNs) appeared in either group. Though MLCRCCs have been considered to be, in general, extremely rare, they do occur in asymptomatic renal cancers. A multiloculated renal mass with thick septum discovered in an adult by ultrasonography or CT scan should be suspected as being a MLCRCC rather than a MLCN.

[A case of tranilast-induced cystitis with transient ECG changes].

A case of tranilast (Rizaben)-induced cystitis accompanied with possibly hypereosinophilic heart syndrome was described. A 75-year-old male, who had been taking tranilast for allergic dermatitis for two months, was admitted for severe bladder stimulating symptoms which was unresponsive to antibiotic therapies. Clinical examination revealed tenderness of the prostate, aseptic pyuria, eosinophilia, liver dysfunction and electrocardiographic disorders including atrial fibrillation, T-wave inversions and lowered ST segment without any cardiac symptoms. Cystitis symptoms, pyuria, eosinophilia and liver dysfunction improved within several days after discontinuance of tranilast, and ST-T changes on ECG gradually normalized within a few months. Tranilast-induced cystitis has been demonstrated as a type of eosinophilic cystitis. Since pathologic findings of eosinophilic cystitis and hypereosinophilic heart syndrome are markedly similar and all symptoms and signs disappeared after deprivation of tranilast, it appears likely that eosinophilic inflammation was induced to the heart, liver, bladder and prostate of the current patient by tranilast.

[Clinical analysis of urinary incontinence in the institutionalized elderly].

Urinary incontinence among institutionalized elderly were analyzed from clinical and social viewpoints. The patient group included 25 males and 107 females with an average age of 78 years (ranged from 66 to 92). They had neither highly impaired performance status nor severe dementia. Forty-nine of them (37%) underwent urological examination. Urge incontinence was common among male patients, while urge, stress or mixed incontinence were prevalent in female patients. Thirty-six per cent of the patients had to use pads, diapers and others for their incontinence, while other needed no special protection for their incontinence. Incontinence caused limitation of social activity in 30% of the patients. Many causal factors were assumed for incontinence in elderly; weakness of the pelvic muscles, urinary tract infection, cerebrovascular disorders, neurological disorders and prior pelvic surgery. Prostatic carcinoma or urethral stricture caused overflow incontinence in a few patients. Diuretics or tranquilizers appeared to lead incontinence in some patients. Nine of 18 patients undergoing cystometry had overactive detrusor. Majority of the incontinent elderly showed no intention to visit clinics. Therefore, it recommended to keep staffs in elderly institutions as well as elderly themselves informed that incontinence in the elderly should be treated, which in turn improves the quality of life.

[A questionnaire survey on micturition problems among institutionalized elderly].

Prevalence of micturition problems among 1,023 institutionalized elderly was surveyed by a questionnaire. The reply was obtained from 821 elderly (80.3%) including 276 males and 545 females with ages averaged 77 years (range 61 to 96 years). They had neither highly impaired performance status nor severe dementia. Micturition problems were complained by 38% of male responders, where micturition difficulty was the most common. On the other hand, 23% of female responders answered having micturition problems and urinary frequency was the most common. One hundred and twenty-four of total responders (15%) replied to have urinary incontinence; 8% in men and 19% in women. Over half of patients with marked objective incontinence denied its presence or refused to answer. Seventy-one per cent of the incontinent elderly had no intention to receive medical care. From the above facts, it seems that many elderly have micturition problems and the incidence of urinary incontinence is latently higher than complained at survey.

[Spina bifida accompanied with neurogenic bladder in a patient who lived to be 81 years old].

Spina bifida accompanied with neurogenic bladder in a woman who lived to be 81 years old was reported. Owing to spina bifida (paralyzed below L4), she suffered from urinary incontinence and gait disturbance. Since childhood, she had voided by Credé's maneuver and used a diaper for urinary incontinence. At the age of 56 years old, cystostomy operation was performed for incontinence. After that, she was free from incontinence. The main reason for her longevity was supposed to be the fact that she could accept good medical care and warm family support. Finally she died of lower abdominal carcinoma.

[Urinary bladder tumor manifesting multiple bone metastases similar to prostatic carcinoma--a case report].

A 72-year-old patient was found to have a non-papillary bladder tumor extending from the vesical floor to the retrotrigone and manifested multiple bone metastases without evidence of any hematogenic metastases in other organs. The pattern of the above metastases were very similar to that of a prostatic carcinoma and suggests that the so-called specific pattern of bone metastases observed in prostatic carcinomas might be caused by the location of the original tumor and not by features of the prostatic carcinoma cells themselves.

[Effects of long-term administration of Tegafur on patients with relapsing advanced carcinoma (stage D) of the prostate].

Daily 600 mg of Tegafur, in addition to antiandrogen therapy, was administered to 20 patients with relapsing prostatic carcinoma at stage D. Thirteen of the patients died and 7 patients are still alive. These patients were evaluated according to the objective response criteria of NPCP . Three patients showed partial regression, 9 patients showed stable prognosis and 8 patients showed progression. The patients who died had a mean survival duration of 77 weeks, which is longer than in other reports on the treatment of relapsing prostatic carcinoma. No severe toxicity was observed in any of the patients. These findings suggest that Tegafur is effective for the treatment of relapsing prostatic carcinoma.