Metastatic testicular germ cell tumour: the role of salvage surgery.

To assess the clinical characteristics of metastatic testicular germ cell tumour, response to chemotherapy and outcome of salvage surgery for residual mass were analyzed. Patients with complete response were carefully watched. Salvage surgery was performed in 14 patients after chemotherapy. Resected specimens showed 7 necrosis/fibrosis, 5 teratoma, 1 cancer, and 1 benign schwannoma. Only necrosis/fibrosis was found in cases without teratoma in the primary tumour. Existence of teratomatous elements in a primary tumour suggests that cancer or teratoma is present in the residual tumour. Furthermore, tumour reduction rate could not predict their presence in resected specimens.

Carboplatin-based combination chemotherapy for testicular cancer: relationship among administration dose of carboplatin, renal function and myelosuppression.

Carboplatin (CBDCA), a derivative of cis-diamminedichloroplatinum, has low renal and neural toxicity. The dose-limiting factor of this agent is myelosuppression. We experienced various degrees of myelosuppression, when the dose of CBDCA was determined by the body surface area (BSA) in CBDCA-based combination chemotherapy for testicular cancer. Calvert demonstrated that the dose of CBDCA administered should be adjusted by renal function, because CBDCA was excreted through the glomerulus. We report the relationship among 3 factors; the administration dose of CBDCA, renal function and the degree of myelosuppression. We treated 6 patients with testicular cancer. A total of 22 courses of CBDCA-based combination chemotherapy was performed. The area under the curve (AUC) was calculated by the following formula, which was demonstrated in Calvert's study. CBDCA dose = AUC x (GFR + 25), GFR; glomerular filtration rate. The degree of myelosuppression was examined. All chemotherapy courses were divided into 2 and 3 groups according to BSA and AUC, respectively. WBC and Plt reduction rates and nadir counts were significantly correlated with AUC, and showed no significant relationship to the dose determined by BSA. This study revealed that the degree of myelosuppression was closely related with AUC, which reflects the renal function.

[Clinical study on 78 cases of testicular tumor].

Seventy eight patients with testicular tumor were treated in our hospital between 1982 and 1992. Of 78 patients, 74 had germinal cell tumor (seminoma in 47 patients and non-seminoma in 27), and the other 4 had 3 malignant lymphoma and 1 rhabdomyosarcoma. Ages ranged from 1 to 67 years with the average of 36.1. The age of the patients with seminoma was significantly higher than that of patients with non-seminoma. Most patients complained of painless swelling of the scrotal content, but some patients complained of testicular pain, fever, and so on. Those who complained of such symptoms had significantly worse prognosis than those who had only painless scrotal swelling. Patients with non-seminoma visited us about 4.9 months after the onset of their symptoms and 12.1 months in seminoma. Clinical stages were more progressive in non-seminoma than in seminoma. Inguinal orchiectomy was performed followed by irradiation, chemotherapy, retroperitoneal lymph node dissection or thoracotomy. Recurrence developed in 6 patients and the other 7 patients died of progressive disease within 2 years from the first attendance. The 2-year survival rate calculated by the Kaplan-Meier method was 81 and 70% in seminoma and non-seminoma, respectively, and 100, 88, 63, 75, and 22% in stage I, IIA, IIB, IIIO and IIIA, B, C, respectively.

[Significance of prostatic specific antigen in the mass screening for prostate cancer].

The significance of prostatic specific antigen (PSA) was investigated in the subjects examined by the mass screening for prostate cancer from 1985 to 1990. All subjects was examined by digital rectal examination (DRE) and with prostatic acid phosphatase (PAP) and the subjects in whom prostate cancer (Pca) was suspected from abnormal DRE and/or elevated PAP were recommended to receive the secondary screening to confirm the presence of Pca. PSA was measured by radioimmunoassay using Ball-Elsa-PSA-kit. 1,600 serum samples were obtained from our serum bank. The relationship among PSA, prostate size estimated by DRE and age was investigated. PSA was increased with age and the prostate size, PSA being more closely related with the latter. Therefore, we estimated that PSA has an ability to detect benign prostatic hypertrophy (BPH) in the mass screening. This estimation should be confirmed by using an ultrasound tomography because the prostate size obtained by DRE is inaccurate as compared with that obtained by ultrasound tomography. The cut off level of PSA was determined by control which was composed from the subjects with normal size prostate and one with BPH. When the cut off level was 8.6 ng/ml, the sensitivity, specificity and efficiency as Pca marker was 73.9%, 97.4% and 97.1%, respectively. PSA was more than 8.6 ng/ml in all of Pca with elevated PAP. PSA was expected to improve the Pca detection rate in our mass screening system.

[Open surgery of elderly patients with benign prostatic hypertrophy].

Thirty three patients with benign prostatic hypertrophy (BPH) over age 80 who had undergone an open prostatectomy at our ward in the period of January of 1968-December of 1987 (20 years), were retrospectively studied for their complications before, during, or after the operation and prognosis. Preoperative complications were observed at a very high rate. When these complications may influence the prognosis, prudent care is required. The incidence of complications during or after the operation seemed also to be slightly high. This is probably because the number of patients with recurring urinary retention or those who had received cystostomy before the operation were relatively high among the elderly people. In such cases especially prudent care is required, for the prognosis may be poor. About 88% of the patients felt better post-operatively and had a good prognosis. In addition, there was no indication of the operation shortening their life. Consequently, an open prostatectomy was considered to be useful for elderly patients.

A case of adenocarcinoma of the renal pelvis.

A 28-year-old female had adenocarcinoma arising from the renal pelvis with ascites containing adenocarcinoma cells. The primary site was treated with radical nephrectomy, resection of the remnant ureter with a bladder cuff. Combination chemotherapy with cisplatin, doxorubicin, and cyclophosphamide (CAP) was performed as an adjuvant therapy. Approximately 3 years after the nephrectomy, she is currently alive with no clinical evidence of recurrence. CAP seems to have been effective in the treatment of the disease.

[A case of testicular infarction in the newborn].

A 6-day-old male was pointed out to have right intrascrotal swelling at birth. Surgical exploration did not reveal torsion of the spermatic cord. The testicle was suspected to have a malignant tumor and then right inguinal orchiectomy was performed. Orchiopexy of the contralateral testicle was not performed due to lack of torsion. Histological examination showed coagulation necrosis of the testicle. Sixty-three cases of testicular infarction in the newborns including our case from Japanese literature were reviewed and discussed.

Comparison of therapeutic efficacy of neuroses between CM6912 (ethyl loflazepate) and diazepam in a double-blind trial.

1. The therapeutic efficacy on several neuroses between CM6912 and diazepam (DZP) was comparatively investigated by means of intergroup comparison method in a double-blind trials. CM6912 was given to CM-1 group on the basis of twice daily dose of 1 mg each in the morning and evening and to CM-2 group on the basis of once daily dose of 2 mg only in the evening and DZP was given to another group on the basis of three times each dose of 2 mg. 2. As for the overall evaluation, no significant differences were found in the percentages of final global improvement rating among three groups. It resulted in "markedly improved" by 22% in CM-2 group, 18% in CM-1 group and 15% in DZP group in order, and "more than moderately improved" by 62% in CM-2 group, 56% in DZP group and 51% in CM-1 group in order. 3. As for the overall safety rating, no differences were found in the incidence of adverse reactions. 4. As for the global utility rating, it resulted in "extremely useful" by 22% in CM-2 group, 14% in CM-1 group and 8% in DZP group in order, showing significant superiority of CM-2 group to DZP group (p less than 0.05). It resulted in "more than useful" by 58% in CM-2 group, 52% in DZP group and 50% in CM-1 group in order.

Lymphangioma of the large intestine. Report of a case.

Lymphangiomas of the large intestine have been reported more frequently since the development and widespread use of the colonic fiberscope. It is possible to endoscopically diagnose lymphangiomas because they are lustrous and smooth on the surface, pliable on compression, and half of them have a stalk or a waist at the base. Lymphangiomas of the colon and rectum under 20 mm in diameter can be safely resected by electrocautery, thereby avoiding unnecessary operation.

[A case report of condyloma acuminata of the urethra].

A 29-year-old man noted a wart around the external urethral orifice. The lesion was diagnosed as condyloma acuminata and he had the tumor excised and circumcision on September 10, 1985. He complained of urethral bleeding on December 21, 1985. Physical and endoscopic examination revealed papillo-granular condyloma acuminata at the distal urethra. He received transurethral fulguration on January 17, 1986 and intraurethral instillation of 5-fluorouracil cream weekly. The lesions were successfully treated.

[Clinical evaluation of norfloxacin in gonococcal urethritis].

Norfloxacin, a new quinolinecarboxylic acid derivative, was administered to 30 male patients with gonococcal urethritis at a daily dose of 600 mg for 7-21 days. The clinical response was evaluated after administration of 7 days as excellent; Negative culture of N. gonorrhoeae. WBC less than 3/hpf in first voided urine sediment, good; Negative culture, WBC greater than or equal to 3/hpf, and poor; Positive culture. The result was excellent in 14 cases and good in 16 cases. No subjective side effects were observed. The minimum inhibitory concentration (MIC) distribution against the clinically isolated 30 strains of N. gonorrhoeae ranged from 0.0096 micrograms/ml to 0.34 micrograms/ml. Seven of thirty strains were resistant to ABPC. The MIC of these 7 strains ranged from 0.018 micrograms/ml to 0.18 micrograms/ml. Seven cases with ABPC resistant strains had a similar clinical response to other cases. Twelve patients (40%) developed post gonococcal urethritis for 7-14 days after treatment. Clinical observation of this series suggests that a 7 day therapy of Norfloxacin for the patients with gonococcal urethritis is sufficiently effective and that treatment should be changed to other antibacterial agents in the case of post gonococcal urethritis, since continuous administration for more than 7 days of Norfloxacin is not so effective.

[Clinical study on prophylaxis of diacetyl-glucaro-(1-4) (6-3) dilactone for recurrence of bladder cancer].

In order to investigate the effect of Diacetyl-glucaro-(1-4) (6-3) dilactone to prevent post-operative recurrence of bladder cancer, we estimated the recurrent rate of 34 patients who were diagnosed as having bladder cancer and treated by several surgical methods and oral administration of the drug in our hospital during 1971 and 1980. The following results were obtained: The 6, 12, 18, 24, 30, 36 and over 36 months-recurrent rates were 3.1%, 26.4%, 32.5%, 32.5%, 32.5%, 46% and 46%. In control group, they were 10%, 23.3%, 34.8%, 46.2%, 73.1%, 73.1% and 100% In a 24 month follow-up, there was no difference of recurrent rate between the group receiving the drug and control group: a recurrent rate of administrated group was lower than that of the control after 24 months. The recurrent rate of the group receiving Diacetyl-glucaro-(1-4) (6-3) dilactone combined with instillation was lower in a 2 year follow-up. It was anticipated that the combined therapy (Diacetyl-glucaro-(1-4) (6-3) dilactone administration and intravesical instillation of anticancer drugs) was useful in order to prevent recurrence of bladder cancer.