[A case of retroperitoneal ancient schwannoma in the pelvis].

We treated a case of retroperitoneal ancient schwannoma in the pelvis detected incidentally at a health examination without clinical manifestation in a 59-year-old Japanese man found to have hypertension. Computed tomography showed a heterogeneously enhanced 8 x 7 cm solid mass in the pelvic retroperitoneal space. Magnetic resonance imaging revealed an encapsulated tumor, showing a low intensity on the T1-weighted image, heterogeneously high intensity on the T2-weighted image and the tumor homogeneously enhanced with Gd-DTPA. It was suspected to be a mesenchymal tumor. The tumor was resected en bloc. The histologic examination of the extirpated tumor was an ancient schwannoma. A total of 11 retroperitoneal ancient schwannoma cases were reviewed.

[A case of mesoblastic nephroma in an adult patient].

We treated a rare case of adult mesoblastic nephroma. The patient was a 52-year-old Japanese man with the chief complaint of intermittent gross hematuria and left lumbar pain. Abdominal ultrasonography, computed tomography, excretory urography, retrograde pyelography and angiography revealed a left renal tumor suspected to be a left pelvic tumor. A left nephroureterectomy was performed. The histologic examination showed a mesoblastic nephroma. A total of 38 adult mesoblastic nephroma cases were reviewed.

[Bacillus Calmette-Guerin intravesical instillation treatment for carcinoma in situ of the bladder. Gifu BCG Instillation Therapy Research Group].

We performed a retrospective long-term study to evaluate the efficacy of intravesical instillation of Tokyo 172 strain Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder. Between 1989 and 1998, 42 patients with CIS of bladder underwent intravesical instillation of BCG. In the follow-up period from 6 to 116 months (mean: 37.3 months), the efficacy rate of intravesical BCG instillation for CIS of the bladder was 81.0%. Two patients died from the bladder cancer. The non-recurrence rate in patients with grade 2 carcinoma (19 cases) was not significantly different from that in those with grade 3 carcinoma (23 cases). However, the recurrence rate in patients with secondary CIS (15 cases) was significantly higher than in those with primary CIS (27 cases). The recurrence of CIS was observed in 7 of 42 cases. In 6 of 7 patients, CIS recurred within one year after treatment. Total cystectomy was performed in 10 of 42 patients, and pathological findings of muscle layer invasion were detected in 8 patients. Although side effects occurred in 33 patients (77.5%), no clinically significant side effects were observed. Our results suggest that intravesical BCG therapy may be useful for the treatment of CIS of the bladder.

[Treatment outcome of radical cystectomy during a 10-year period (June 1984-September 1994) at Department of Urology, Fukui Medical School].

The treatment outcome was evaluated in 63 patients with bladder cancer more than 2 years after cystectomy. Cisplatin-based combination chemotherapies were given to 40 patients after the operation as an adjuvant therapy and two patients with T4 or N2 bladder cancer received chemotherapy before the operation as a neoadjuvant therapy. The extent of infiltration of the removed tumors was pTa in 5, pT1 in 18, pT2 in 8, pT3a in 6, pT3b in 17, and pT4 in 9 cases. Regional lymph node metastases were present in 10 cases (16%). Nineteen patients died of tumor recurrences. The 5-year acturial survival rates at each stage were 60% for stage pTa, 78% for stage pT1, 63% for stage pT2, 83% for stage pT3a, 33% for stage pT3b and 38% for stage pT4, respectively. A significant difference (p < 0.05) in survival curve was observed between pT3a and pT3b. The prognosis of patients with tumors extending beyond the bladder muscles is extremely unfavourable, with the exception of bladder cancers infiltrating the neighboring organ (pT4a), the removal of which may result in lasting survival in a part of the cases. Effective adjuvant treatment is required for patients with bladder tumors penetrating the bladder wall.

[Intermittent administration of 15-deoxyspergualin for acute on chronic rejection after renal transplantation].

We used 15-deoxyspergualin (DSG) to treat acute on chronic rejection (AOCR) in six kidney transplant recipients. DSG was administered intermittently at a dose of 200-300 mg per body every 2 or 4 weeks for more than 6 months. The efficacy of DSG was evaluated by the changes in serum creatinine values during the rejection therapy. Four (67%) of the six patients responded with the suppression of the increase in serum creatinine values. On the other hand, one patient did not respond at all and developed advanced pancytopenia. These findings suggested that intermittent administration of DSG would be efficient therapy on AOCR in the renal allografts if the patients were treated carefully to prevent severe side effects.

[Current concept and problems of urinary diversion. 2. Selection of operation: reservoir].

The Kock continent urinary reservoir was constructed in 12 patients from 1988 to 1990 followed by the Indiana continent urinary reservoir in 14 patients thereafter. There were no perioperative death in either group. The period of postoperative follow-up was 11 approximately 70 months, with a mean of 58.9 months. Several modifications of the operative technique were made to the original Kock pouch, but stone formation was observed in 5 patients (42%), resulting from foreign materials permanently in contact with urine. In the Indiana pouch group with a mean postoperative follow-up period of 26.8 months (range 11 approximately 43 months), wound infection occurred in the initial 4 patients and difficulty of catheterization in the other 4 patients. The serum electrolyte values were found to be within the normal limits during the follow-up period in both groups, but, mild acidosis occurred in 2 patients. Patients with urinary diversion demonstrated mild azotemia (P = 0.02) despite similar serum creatinine levels and an increase in urine pH (P = 0.006) postoperatively. Asymptomatic bacteriuria was demonstrated in 22 of the 26 (83%) patients with the reservoir, but only 5 patients had significant pyuria. Our clinical experience suggests that the Indiana pouch is a more reliable method than the Kock pouch to construct a continent urinary reservoir.

[Experimental studies on evaluation of rat testicular function by 31P magnetic resonance spectroscopy].

To evaluate the efficacy of 31P magnetic resonance spectroscopy (31P MRS) as a diagnostic method for abnormal testicular function, we examined three conditions using rat testes, ischemia, irradiation, and hormone manipulation. 1) Ischemia: Immediately after clamping of the feeding vessels, ATP signals began to fall and disappeared within 60 minutes. With the release of blood supply after 3 hours of ischemia, ATP appeared within 2 hours. However, after more than 4 hours of ischemia, ATP did not recover within 2 hours and the testis became necrotic after 1 week. 2) Irradiation: 31P MRS of the testis 2 weeks after irradiation with 10 Gy., 9 MeV showed a significant decrease (P < 0.05) in the PME/beta-ATP ratio from 1.30 +/- 0.11 (control level) to 1.11 +/- 0.12 and a decrease in PME/PDE ratio from 1.43 +/- 0.17 to 1.13 +/- 0.20. However 3 weeks later, the PME/beta-ATP ratio recovered to a control level. 3) Hormone manipulation: In the testes 5 weeks after weekly intramuscular injections of estradiol benzoate and testosterone enanthate, PDE/beta-ATP ratio significantly increased (P < 0.01) from 0.83 +/- 0.09 (control level) to 1.03 +/- 0.19. 31P MRS is a non-invasive method for evaluation of various testicular abnormalities, and ATP signals may be useful to evaluate an acute ischemic change for example testicular torstion and the changes of PME, PDE signals may be useful parameters in the assessment of the status of spermatogenesis.

[Experimental studies on evaluation of the effects of radiotherapy and chemotherapy in urogenital tumors using 31P-magnetic resonance spectroscopy].

The effects of local irradiation and intraperitoneal injection of cisplatinum (CDDP) and VP-16 were examined in the sequential 31P magnetic resonance spectroscopy (MRS) in testicular cancer (TC-1) and bladder tumor (BT-8) of human origin, serially transplanted in nude mice. In the early phase of tumor growth, high-energy phosphate metabolites such as phosphocreatinine (PCr), adenosine triphosphate (ATP) and phosphomonoester (PME) were detected in both grafted tumors. However, the relative value of inorganic phosphate (Pi) to PCr increased with the growth of the tumor. Irradiation had the most pronounced effect to inhibit growth, followed by CDDP in both strains. However, growth inhibition was not observed in the VP-16 group. The effect of irradiation on the tumor histology was severely expressed in the nucleus and cytoplasm on the 4th to 7th day. The high PCr/Pi ratio during 2 to 14 days after irradiation suggested reoxygenation in the tumors with a high hypoxic cell fraction. In the CDDP and VP-16 groups, without histological change, the changes of PCr and Pi were milder than that in the irradiation group. Thus the spectroscopic analysis is presumably expected to give us an earlier and more accurate information on the tumor than the conventional parameters.

[The enhancement of the chemotherapeutic effects on human prostate cancer cell--the combination with the growth factor interaction inhibitor (suramin)].

The present study was designed to evaluate the antiproliferative effects of suramin and the combination of suramin plus cisplatin (CDDP) on the hormone-independent human prostate carcinoma cell line (PC-93). In vitro, suramin induced a dose-dependent reduction of PC-93 proliferation, and at the clinically achievable concentration (300 micrograms/ml), suramin induced a 19.7% decrease in proliferation on the 3rd day compared to suramin-free control (P < 0.01). However, from the 4th day on the inhibitory action of suramin was reversed following exposure. The suramin-cisplatin combination showed an additive effect (inhibition ratio 32.4% on the 3rd day), and prolongation of the inhibition activity on the 4th day on, but it did not show any synergistic effect. Suramin inhibited dose-dependently the growth stimulatory effect of exogenous epidermal growth factor (EGF). In vivo study, suramin and suramin-cisplatin combination showed antitumor effects continuously in nude mouse implanted PC-93. These findings suggest that the inhibitory effects of suramin on PC-93 are mediated by inhibition of the EGF-mediated growth mechanism, but by a cytostatic rather than cytotoxic manner in vitro. In addition, other mechanisms such as inhibition of angiogenesis factor might exist in vivo.

[Esophago-bronchial fistula caused by chemotherapy with bronchial artery infusion for pulmonary metastases from urinary tract cancer].

We treated a patient who had had postchemotherapeutic pulmonary metastases from urinary tract cancer by bronchial artery infusion (BAI) chemotherapy. Pulmonary lesions showed a 33.0% reduction after the treatment. However, esophago-bronchial fistula (EBF) occurred after the second BAI. The patient died of recurrent aspiration pneumonia and sepsis in the sequelae of the repair surgery. The fistula was considered to have resulted from an increase in the blood flow to the esophageal branch originating from the bronchial artery after the first BAI, which had consequently damaged the local tissue due to accumulation of anti-cancer drugs. In order to avoid these complications, the secondary change of blood flow should be examined precisely by preceding angiographical mapping, and the concentration and the infusion speed of the cytotoxic drugs, should be under adequate control.

[Antiandrogen therapy of benign prostatic hyperplasia--review of the agents evaluation of the clinical results].

Various non-surgical therapeutic modalities such as balloon dilation of the prostatic urethra, hyperthermia of the prostate and medication with antiandrogens and/or adrenergic blockade have been attempted for the patients with benign prostatic hyperplasia (BPH) especially in an early stage or in a poor operative risk. The observation that androgen deprivation induces shrinkage of the hyperplastic prostate represents the basis for the treatment of BPH with antiandrogen. Although several antiandrogens are now in clinical use in our country, there still remain problems to be solved. We reviewed the mechanism of action and the clinical results of antiandrogens in the treatment of BPH. The improvement following antiandrogen therapy occurred among the patients with symptomatic BPH, in 50-80% subjectively and in 40-50% objectively. The therapy appeared to be more effective in an early stage of the disease. However, the limitation of the duration of the effects and unfavorable side effects should also be noticed. The progestational agents such as gestonorone caproate, chlormadinone acetate and allylestrenol suppress more or less sexual function by interference of the pituitary-gonadal axis. Besides, coincidental prostate cancer must be excluded since antiandrogen therapy might hinder the natural course of the cancer.

[Study of incidental carcinoma of the prostate. II. Nuclear DNA analysis].

The clinical significance of cytofluorometric nuclear DNA analysis, ploidy pattern and DNA content, was investigated in 47 incidental prostatic carcinomas, 24 stage A1 and 23 stage A2 cases, 9 clinically advanced cases and 25 BPHs. The results were compared to clinical stage and histological differentiation. The mean nuclear DNA content of stage A1 cancer, which was similar to BPH, differed from that of stage A2 cases. The latter was almost identical to that of advanced cases. In moderately and poorly differentiated carcinomas it was higher than that of well differentiated ones. A non-diploid pattern was distributed in 33% of stage A1, 78% of stage A2 and 89% of clinically advanced cases. It was detected in 42% of the well-, 77% of the moderately- and 100% of the poorly differentiated adenocarcinomas. The DNA analysis of incidental prostatic cancer thus correlated well to the clinical and pathological parameters. If limited to well differentiated carcinomas, however, 17% of the stage A1 cases showed an aneuploid, and 29% of the stage A2 cases, a diploid pattern. No diploid pattern was detected in clinically advanced cases. Although we have not been able to prove any difference in prognosis in the present cases, these findings suggest that the nuclear DNA analysis is another parameter in defining the prognosis of incidental prostatic carcinoma. Further follow-up of the patients and accumulation of the data are necessary to determine the clinical validity of this method.

[Study of incidental carcinoma of the prostate. Part 1. Pathological analysis related to the clinical features].

To clarify the clinico-pathological characteristics of incidental carcinoma of the prostate, we investigated a total of 590 prostatic tissues which had been operated under the diagnosis of benign prostatic hyperplasia (BPH), including 12 whole prostatic specimens which were obtained by total cystectomy due to bladder cancer. Histological examination and estimation of the tumor volume were carried out by either a 3-mm step-section in 185 prostates obtained by open surgery, or by mounting whole specimens in 405 TUR cases. Incidental cancers were detected in 69 of the 590 patients (12%) with nearly equal numbers of stage A1 and stage A2 diseases. The age and the size of the prostate were significantly greater in the patients with cancer, compared to those without cancer. However, these parameters were not in agreement with each other. Histological analysis revealed that 46 of the 69 (67%) incidental cancers were well differentiated and nearly corresponded to Gleason's sum score of 2-4. In the analysis of the differentiation of the tumor cells and the tumor extension, nearly 80% of the 23 well differentiated cancers were manifest in a single lesion and were smaller than 0.3 cm3, whereas 90% of the 11 moderately or poorly differentiated cancers were diffusely invasive. Six of the 11 cases (55%) were larger than 0.3 cm3. The prognosis of the 16 incidental cancer patients who had survived more than 5 years after the surgery were compared with the controls. The controls were selected among the cases without incidental cancer, and matched for age and the time of operation in a 1 to 2 fashion without knowledge of their prognoses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thymidylate synthase inhibition and concentration of 5-fluorouracil after administration of UFT in human uroepithelial carcinomas].

Inhibition of thymidylate synthase (TS) and the concentration of tegafur, 5-FU and uracil in the tumor and the non-tumor tissues were compared in 18 uroepithelial cancer patients who had been administered UFT (600 mg/day) for seven days before operation. 5-FU and uracil levels in the tumor tissue were increased to 5.1 and 3.6 fold, respectively, compared those in the normal tissue, although there was no difference in tegafur levels between normal and tumor tissue. The mean inhibition rate of TS activity in the tumor tissue was significantly higher (36%) than that in the normal tissue (21%). However, no correlation between 5-FU level and inhibition rate of TS activity was found in either tissue. Not only the higher tumor concentration of 5-FU but also the higher inhibition of TS activity in the tumor tissue suggests that UFT is likely a useful drug for the treatment of uroepithelial carcinomas.

[Ultrasonographic assessment of intravesical urine volume].

The assessment of intravesical urine volume is very important in the management of the patients with lower urinary tract obstruction or incontinence. As the non-invasive method for measuring residual urine volume, accuracy and usefulness of ultrasonographic measurement was evaluated in a total of 116 occasions in comparison with the conventional catheter technique. The values of the maximum transverse (W), cranio-caudal (H) and antero-posterior distance (D) of the inflated bladder were obtained by trans-abdominal scanning. These parameters were used for the ellipsoid formula (pi/6 x W x H x D). The ultrasonographic measurement of urine volume showed a high coefficiency against the conventional catheterized volume (r = 0.9543). Although a mean standard error was 56.3% of the actual volume, the amount of residual urine at the target of 50 ml and 100 ml could be accurately assessed by ultrasound with an accuracy of 90.5%. The method was also valid in follow-up study to monitor the changes of residual urine volume. The ultrasonographic assessment of intravesical urine volume is, thus, a non-invasive, useful tool in the management of the patients with voiding disturbance.

[A case of primary signet ring cell carcinoma of the bladder].

A 41-year-old man visited our clinic with complaints of gross hematuria and pain on urination. Cystoscopic examination revealed papillary and sessile tumor at the retrotrigone of the bladder and the specimen of the transurethral biopsy showed signet ring cell carcinoma. Since there was no primary tumor in any other organs, we diagnosed it as a primary signet ring cell carcinoma of the bladder. Total cystectomy with Kock continent ileal reservoir and post-operative chemotherapy consisting of cisplatinum, adriamycin and 5-FU were performed. The literature on the pathological findings of this disease are reviewed.

[Clinico-pathological investigation on frequency and prognosis in patients with incidental prostatic carcinoma: preliminary report].

To investigate the relationship between some clinico-pathological features of incidental prostatic carcinoma and its prognosis, totally 96 consecutive cases with simple prostatectomy from 1968 to 1973 under the diagnosis of prostatic hypertrophy were examined by the 3 mm step-section technique. Twenty-one cases (21.9%) of incidental carcinoma were detected histologically. The age of the patients with or without prostatic carcinoma ranged from 59 to 81 years old, 72.0 years old on the average, and from 54 to 87 years old, 69.9 years old on the average, respectively. The weight of the specimen varied from 7 to 84 grams, 32.4 g on the average, for the patients with carcinoma, and 10 to 64 grams, 29.7 g on the average, for the patients without carcinoma. Fifteen of 21 cases showed well differentiated carcinoma. None of the Japanese histological differentiation, Gleason's classification and volume of carcinoma presumably affected the survival of the patients.

[A case of embryonal rhabdomyosarcoma of the spermatic cord].

A case of rhabdomyosarcoma of the spermatic cord in a 6-year-old boy is reported. On February 26, 1986, he visited Nakamura Hospital with the chief complaint of enlargement of the left scrotal content. The contralateral scrotum was normal. The left scrotal content was a hard thumb-head-sized tumor. The left testis and epididymis were not distinguishable from the tumor. On the same day, left high inguinal orchiectomy was performed. The tumor was 3.5 by 2.5 by 2.5 cm in size and was distinguishable from the testis, epididymis and tunica vaginalis. Histopathological findings were embryonal rhabdomyosarcoma and it appeared to have originated from the spermatic cord. Two years after operation, the boy is living without metastasis. Including our experience, 101 cases of the paratesticular rhabdomyosarcoma found in Japanese literature are reviewed and briefly discussed.

[Two cases of acute renal failure associated with non-typhoid Salmonella infection].

Two cases of acute renal failure associated with non-typhoid Salmonella infection are reported. Case 1: A 49-year-old man was admitted with the complaint of severe watery diarrhea and oliguria. Stool culture revealed Salmonella typhimurium. Laboratory data showed hyponatremia and acute renal failure. Hemodialysis was performed 3 times and renal failure was improved. Case 2: A 63-year-old woman was admitted with complaint of severe watery diarrhea, nausea, and fever. Stool culture revealed Salmonella E group. Septic shock appeared after admission, and anti-shock therapy was immediately carried out. Acute renal failure was cured without hemodialysis, even though multiple organ failure had occurred concomitantly. We discussed the management of patients with Salmonella infection, especially those with acute renal failure.

Activity of fosmidomycin in an in vitro model of the treatment of bacterial cystitis.

The response to fosmidomycin of four strains of Escherichia coli was studied in an in vitro model of the treatment of bacterial cystitis. Three susceptible strains of E. coli responded well to relatively low concentrations of fosmidomycin: doses achieving peak concentrations of 50 or 250 mg/l suppressed bacterial growth for 13 h or more; however, when the surviving bacteria were challenged with a second dose, a reduced response was observed. When a fully resistant strain was exposed to fosmidomycin, bacterial growth was also suppressed for 13 h or more, even when the peak concentration achieved was below the conventionally determined minimum inhibitory concentration. Resistant variants which emerged after exposure to fosmidomycin were also resistant to fosfomycin in the absence of the potentiating agent, glucose-6-phosphate. In the presence of glucose-6-phosphate, complete (or partial) susceptibility to fosmidomycin and fosfomycin was retained by three of the four strains. These results suggest that fosmidomycin and fosfomycin are transported into E. coli by a similar mechanism, and that deletion of the hexose phosphate transport system does not occur following exposure to fosmidomycin in the absence of glucose-6-phosphate.