[Case report: simultaneous bilateral testicular tumors with different cell types].

A 29-year-old man was admitted to our hospital due to bilateral testicular tumors. The bilateral testicular tumors were palpated and visualized by ultrasound and magnetic resonance imaging (right 8 cm, left 6 cm in diameter). Bilateral high orchiectomies were performed after frozen storage of the sperm. Pathological examination revealed seminoma and immature teratoma in the right testis and seminoma in the left testis. Three months later, computed tomography (CT) showed multiple metastatic lung nodules. In addition, positron emission tomography (PET)-CT examination revealed peri-caval lymph node metastasis together with the lung metastases. Lung metastases disappeared, but the lymph node metastasis reduced and remained after 3 courses of combination chemotherapy with bleomycin, etoposide and cisplatin. PET-CT examination revealed that no uptake of FDG was seen in the lung and lymph nodes. Retroperitoneal lymph node dissection was performed. No viable tumor cells were histologically present in the excited lymph nodes. The postoperative course was good and uneventful at 10 months under androgen replacement therapy without disease recurrences.

Long-term results of combined chemotherapy with gemcitabine and cisplatin for metastatic urothelial carcinomas.

BACKGROUND: This retrospective study aimed to determine the long-term effects and toxicity of a combined chemotherapeutic regimen of gemcitabine and cisplatin (GC) in the treatment of metastatic urothelial carcinomas (UCs). METHODS: Seventy-one patients with metastatic UC were treated with GC (gemcitabine 1000 mg/m(2) on days 1, 8, and 15 and cisplatin 70 mg/m(2) on day 2 every 28 days). The patients were divided into 3 groups: patients who had not undergone prior chemotherapy (group 1), patients who relapsed more than 6 months after being treated with the prior cisplatin-based regimen (group 2), and patients in whom the prior cisplatin-based regimen demonstrated no effect (group 3). The median follow-up was 42 months. RESULTS: In group 1, 20 of the 32 patients (63%) showed an objective response, with 6 achieving a clinically complete response (CR) and 14 a partial response (PR) with GC. Ten of 32 patients (31%) and 1 of 7 patients (14%) showed objective responses in groups 2 and 3, respectively. Patients in group 2 who had previously been treated with regimens other than GC showed a better objective response (58%) than those with GC (15%). The median time to progression in group 1 was 6 months, and the median overall survival was 14 months. In all, the nonhematological toxicities associated with GC were quite mild. Grade 3-4 toxicity was primarily hematological, including anemia (19%), neutropenia (36%), and thrombocytopenia (42%). CONCLUSIONS: GC is therefore considered to be a highly effective and well-tolerated regimen with moderate toxicity for the treatment of metastatic UCs.

[Intrascrotal rhabdomyosarcoma in adult: a case report].

The patient was a 34-year-old man presenting with the right intra-scrotal painless mass. With a diagnosis of right intrascrotal tumor, the patient underwent right high orchiectomy. The pathological diagnosis of pleomorphic rhabdomyosarcoma arisen from the right spermatic cord was made. Computed tomography revealed a single metastasis in the para-vena cava lymph node. Systemic chemotherapy with vincristine, actinomycin D, plus cyclophosphamide (VAC therapy), and etoposide plus cisplatin (EP therapy) were made according to Intergroup Rhabdomyosarcoma Study (IRS)-IV Regimen 45. But the chemotherapy was ineffective and a retoroperitoneal lymphadenectomy (RPLND) was therefore performed. After 3 months following RPLND, the tumor relapsed in a pelvic lymph node involved in right ureter and ileocaecal valve. Resection of the tumor with ileocaecum was performed and then intraoperative radiotherapy (15 Gy) against the tumor bed was performed to ensure the curative effects. After his recovery, he received a total of 6 courses of systemic chemotherapy consisting of vincristin, ifosphamide, etoposide (IRS-IV Regimen 47). The patient was rigorously followed up for 42 months after the final chemotherapy, with no tumor recurrence.

Peak flow rate is the best predictor of acute urinary retention following prostate brachytherapy: our experience and literature review.

OBJECTIVES: We prospectively investigated risk factors for acute urinary retention (AUR) following transperineal radioactive seed implantation for prostate cancer. METHODS: A total of 273 consecutive patients underwent transperineal ultrasound-guided prostate brachytherapy for clinical T1c-T3b prostate cancer. Preoperative factors included age; International Prostate Symptom score; planimetric prostate and transition volumes (TZV) measured by transrectal ultrasound; peak flow rate; post-void residual urine; neoadjuvant hormone therapy; use of pelvic radiation; and T stage. Intra- and postoperative factors included the number of seeds and needles. RESULTS: Ten patients (3.6%) showed AUR requiring catheterization. Among preoperative factors, age, International Prostate Symptom score, planimetric prostate volume, planimetric prostate volume and radiation therapy (RT) were not significantly correlated with AUR. PFR (P = 0.012) and PVR (P = 0.020) of patients having AUR were significantly higher than those not having AUR. Mean TZV was also significantly higher (P = 0.038) in the AUR group univariate analysis. Multivariate analysis showed that PFR is the only independent predictor of AUR (P = 0.030). CONCLUSION: On univariate analysis, PFR, PVR and TZV were found to be statistically significant predictors of AUR following seed implantation. According to multivariate analysis, only PFR was confirmed to be a significant predictor.

Comparison of prostate and transition zone volume measured by the ellipsoid and planimetric methods with transrectal ultrasonography before seed implantation of prostate cancer.

A total of 122 men who were diagnosed with localized prostatic cancer underwent transrectal ultrasound and the volumes of their prostates and transitional zones were obtained using the planimetric method and the ellipsoid method. Mean age was 64.2 +/-13.4 (48.2-85.8), and mean preimplant prostate specific antigen was 6.01 +/- 2.35 mg/mL (0.92-15.5). The clinical stage was T1c in 70 patients, T2a in 46 and T2b in 6. Prostatic volumes and transitional zone volumes obtained by the planimetric method were 18 % and 39% greater than those obtained by the ellipsoid method, respectively. There were significant differences between the volumes obtained by the two different methods. However, there was a good correlation between the prostatic volume and the transitional zone volume obtained by both the ellipsoid method (r = 0.851) and the planimetric method (r = 0.908). The regression line of the prostate volume between these two methods was calculated as .

Gemcitabine and cisplatin for advanced urothelial carcinomas: the Ehime University Hospital experience.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of a combined chemotherapy regimen, gemcitabine and cisplatin (GC), in the treatment of advanced urothelial carcinomas. METHODS: Fifty-five patients with advanced urothelial cancer were treated with GC (gemcitabine 1000 mg/m(2) on days 1, 8, and 15; cisplatin 70 mg/m(2) on day 2) every 28 days. The median follow-up was 30 months (range, 3 to 57 months). RESULTS: With the GC therapy, 35 of the 55 patients (63.6%) showed an objective response, with 7 (12.7%) achieving a clinical complete response (CR) and 28 (50.9%), a partial response (PR). GC therapy had a better impact on metastases in the lung and lymph nodes than on metastases in the liver and bone. Lung and lymph nodes showed objective responses of 64.7% and 65.8%, respectively. Eight of the 20 patients (40.0%) who had previously been treated with other regimens showed an objective response, with 1 achieving a CR and 7 achieving a PR. In the 47 patients with metastasis, the median time to progression was 7.0 months (range, 2 to 49 months), and the median overall survival was 12.0 months (range, 3 to 49 months). The 2-year survival rate was 80.0% in the CR group, while it was 55.1% in the PR group and 10.0% in the progressive disease (PD) group. The toxicities associated with GC, particularly mucositis, anorexia, and alopecia, were quite mild. Grade 3-4 toxicity was primarily hematological, including anemia (27.3%), neutropenia (32.7%), and thrombocytopenia (43.6%). CONCLUSION: GC is considered to be a highly effective and well-tolerated regimen for the treatment of advanced urothelial carcinomas, with moderate toxicity.

[Gemcitabine and cisplatin therapy in advanced or metastatic urothelial cancer: comparison of side effect with MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin)].

OBJECTIVE: Cisplatin-based combination chemotherapy has been considered as standard therapy for advanced or metastatic urothelial carcinoma. A recent study has, however, revealed that gemcitabine may have the potential to act synergistically with cisplatin. Therefore, the side effects of gemcitabine plus cisplatin (GC) therapy were compared with those of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) therapy in patients with advanced or metastatic urothelial carcinoma. PATIENTS AND METHODS: Twenty-two patients received GC therapy. Gemcitabine (1000 mg/m2) was administered on days 1, 8 and 15 of each 28-day cycle. Cisplatin (70 mg/m2) was administered on day 2 of each cycle. As a control group, 24 patients received MVAC therapy (methotrexate at 30 mg/m2 on days 1, 15, 22, vinblastine at 3 mg/m2 on days 2, 15, 22, doxorubicin at 30 mg/m2 on day 2, and cisplatin at 70 mg/m2 on day 2 of each 28-day cycle. RESULTS: In the group of patients which received GC therapy, the overall response rates based on independent radiologic reviews of the 20 patients with measurable disease were 55%, with 20% CR and 35% PR. Fewer GC patients as compared with MVAC patients had grade 3/4 anorexia (4.5% vs. 75%, respectively), stomatitis (9.0% vs. 66.7%, respectively), and alopecia (27.3% vs. 100%, respectively). On the other hand, there were no significant differences in the incidence or pattern of hematologic toxicities between the group receiving GC therapy and that receiving MVAC therapy. Fatal neutropenic sepsis occurred in one patient receiving MVAC therapy. CONCLUSION: GC therapy is effective for the treatment of advanced or metastatic urothelial carcinoma, with an acceptable clinical safety profile. This study also indicates that GC therapy may be better tolerated and safer than MVAC therapy.

Primary retroperitoneal lymphocele in a pregnant woman: the first report.

In a 32-year-old pregnant woman, routine ultrasonography revealed right hydronephrosis and a huge retroperitoneal mass (20 x 7 cm) containing a fluid collection. Percutaneous drainage of the mass was performed and 2 L of clear, yellowish fluid was collected. Four months following the delivery, a recurrent retroperitoneal lymphocele was identified. Six months after the delivery, laparoscopic marsupialization was performed through a 10-mm umbilical camera port and two 5-mm ports on the right side of the abdomen. A posterior peritoneal window was established by creating a wide opening in the anterior wall of the lymphocele. Subsequent ultrasonography did not indicate a recurrence of the lymphocele or right hydronephrosis over a follow-up period of 8 months.

Application of cardiopulmonary bypass for resection of renal cell carcinoma and adrenocortical carcinoma extending into the right atrium.

AIM: The application of cardiopulmonary bypass to atrial involvement represents an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking. Our experiences of the management of extended thrombi into the right atrium in patients with retroperitoneal malignancy using a cardiopulmonary bypass were discussed. METHODS: Data were reviewed for five patients (two men and three women; mean age, 60.4 years; range, 49-79 years) with retroperitoneal tumors displaying intracardiac tumor extension. Tumors originated in the right kidney in four patients, and in left adrenal gland in one patient. Cardiopulmonary bypass was used in all cases. RESULTS: Mean total blood loss was 6059 mL. Mean operative time was 14.7 h. No intra- or postoperative complications due to surgical technique were encountered, and no significant bleeding occurred during incision of the inferior vena cava or after removal of tumor thrombus. The follow-up period ranged from 3 to 20 months with a mean of 12.6 months. Of the five patients, three died of metastatic diseases, one died of liver dysfunction and one remains disease free as of 18 months postoperatively. CONCLUSIONS: Our experience indicates that this procedure can be safely used for atrial involvement. Although superior long-term survival cannot be shown yet, favorable early results and a lack of perioperative complications were identified.

[Cytomegalovirus infection in peptic ulcer in renal transplant recipient: a case report].

Gastroduodenal ulcers in renal transplant recipients are usually originated from excessive acid secretion or infection of Helicobacter pyroli. Herein, we report a case of cytomegalovirus (CMV)--induced gastric ulcer following cadaveric renal transplantation. The patient was a 48-year-old man with chronic renal failure and received cadaveric renal transplantation. A month later, he had epigastralgia without CMV-positive antigenemia and received gastrointestinal fiberscopy. Endoscopically, gastric ulcer was identified. Histological findings revealed conspicious nuclear enlargement of the non-epithelial cells in the ulcer bed, which indicated CMV infection. The patient was treated with ganciclovir for 2 weeks and the symptom was relieved. He discharged with a good renal function on day 75 posttransplant. CMV infection plays an important role in gastric ulcer after renal transplantation. Antigenemia assay dose not seem feasible for the detection of CMV-induced gastric ulcer.

Effects of angiotensin II receptor blocker on proteinuria in renal transplant recipients.

INTRODUCTION: Therapeutic approaches directed at reducing proteinuria are under development. The aim of the present study was to prospectively elucidate the impact of losartan treatment in renal transplant recipients with persistent proteinuria. PATIENTS AND METHODS: Twenty-eight patients with persistent proteinuria or mild hypertension were assigned to receive losartan. Proteinuria was defined as a ratio of urinary protein to urinary creatinine (U(P)/U(Cr)) >0.5 in continual urinary tests in the outpatient setting. RESULTS: All patients with mild hypertension reached target blood pressure (BP) with losartan treatment, but the change was not significant. In twelve patients with proteinuria before initiation of the study, urinary protein excretion was significantly reduced with treatment. No correlation was observed between reductions in proteinuria and mean BP. A significant decrease was identified in the hemoglobin concentration of patients with serum creatinine concentrations >2.0 mg/dl before the study. DISCUSSION: Losartan efficiently reduces proteinuria in renal transplant recipients with adequate tolerance. Multicentric prospective studies are required to confirm its clinical effectiveness.

Cavernous hemangioma of the urinary bladder in an 8-year-old child.

An 8-year-old boy was admitted to Ehime University Hospital, Ehime, Japan, for the further investigation of a 5-month episode of gross hematuria accompanied by lower abdominal pain. Magnetic resonance imaging revealed a solid tumor measuring 3 cm in diameter of the bladder wall. Cystoscopy demonstrated a red, wide-based, nodular tumor situated on the dome of the bladder. Histological examination of tissue taken at hot biopsy showed fibrolipoma. In consideration of potential malignancy, a partial cystectomy was carried out after informed consent was given. Histological examination of the resected specimen showed it to be cavernous hemangioma.