[Effectiveness of DMSO intravesical therapy for lower urinary symptoms of primary amyloidosis localized in the urinary bladder : a case report].

Primary amyloidosis localized in the urinary bladder is comparatively rare,and 40% of the patients complain of lower urinary tract symptoms (LUTS). Although standard management for amyloidosis localized in the urinary bladder is not established,transurethral resection (TUR) is performed in most of the cases to diagnose the disease and to control bleeding. TUR is not considered as radical therapy for amyloidosis localized in the urinary bladder because of frequent recurrence. Dimethyl sulfoxide (DMSO) administered through intravenous,percutaneous or intravesical route has been shown to be effective for treating and preventing recurrence of the disease,but its effect on LUTS due to amyloidosis localized in the urinary bladder has not been demonstrated. We report a case showing improvement of LUTS and in which recurrence of amyloidosis localized in the urinary bladder was prevented for 18 months by intravesical DMSO therapy.

[Annular rectal constriction caused by infiltrating bladder carcinoma: a case report].

A 64-year-old man was referred to our hospital with chief complaints of gross hematuria and pollakisuria. Cystoscopic examination showed non-papillary broad basis tumor on the left lateral wall involving the left ureteral orifice. Computed tomography (CT) and magnetic resonance imaging revealed left hydronephrosis and urinary bladder tumor which extended outside of the bladder wall. Transurethral biopsy showed grade 3 urothelial carcinoma with glandular differentiation including signet ring cells. Radical cystectomy, left nephrureterectomy and right ureterocutaneostomy were performed. Pathological examination showed urothelial carcinoma; pT3aN0. Lymph node metastasis occurred five months later. Three courses of M-VAC chemotherapy (methotrexate, vinblastine, adriamycin, cisplatin) were done with little effectiveness. Sixteen months after the operation, he complained of anorexia and tenesmus, and CT showed annular thickening of the rectal wall. A fecal diversion was performed, but he died two months later.

[A case of Fournier's gangrene reconstructed with negative-pressure bolster for free skin grafts: a case report].

A 44-year-old male with a history of diabetes mellitus and alcoholism for 20 years, was admitted to our hospital complaining of urinary retention and high fever. The scrotum was swollen and became necrotic partially. The inflammation and emphysema was around the anus, bilateral inguinal region, and right flank. The laboratory data showed disseminated intravascular coagulation (DIC). According to the clinical and radiological findings, we diagnosed the illness as Fournier's gangrene. Cystostomy and surgical debridment were performed in conjunction with the use of broad-spectrum antibiotics and anti-DIC therapy. After the general condition improved, the broad defect of perineal skin was covered with a free skin graft by using the negative-pressure bolster method. The graft was successful.

Bilateral spermatocele concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling.

We report the very rare case of bilateral spermatoceles concurrent with bilateral scrotal hydrocele presenting huge scrotal swelling. A 52-year-old man came to our hospital because of large scrotal swelling. Ultrasonography and magnetic resonance imaging showed bilateral large scrotal hydroceles concurrent with bilateral multicystic spermatoceles above the hydrocele. He had no history of vasectomy or scrotal injury, and the semen examination was normal. The contents of the hydroceles and spermatoceles were first aspirated, but hydrocelectomy and spermatocelectomy were eventually done because after the aspiration the fluid increased more rapidly. Bilateral spermatocele is very rare; moreover, this is the first report of bilateral spermatocele concurrent with bilateral hydrocele.

[A case report of sarcomatoid carcinoma of the urinary bladder].

A 49-year-old female visited to our department with complaints of gross hematuria and micturition pain. Cystoscopic examination revealed a 5-cm diameter solid broad-based tumor located at the front wall of the bladder. Histologically, the tumor was composed of grade 2 urothelial carcinoma (UC) element and sarcomatous spindle cell element. Immunohistochemical examination demonstrated that both UC and spindle cells were positive for cytokeratin. In addition, spindle cells did not stain for S-100 protein or smooth muscle actin. We diagnosed the tumor as sarcomatoid carcinoma and performed total cystectomy and ileal conduit without chemotherapy and radiation. The patient has remained without any evidence of recurrence for 14 months after operation. Sarcomatoid carcinoma of the bladder has aggressive malignant potential and poor prognosis. An appropriate adjuvant therapy for sarcomatoid carcinoma with metastasis has not been established. Total cystectomy is recommended as soon as possible after pathological diagnosis in the same manner as conventional high grade UC.

Long-term functional outcomes of ileal and sigmoid orthotopic neobladder procedures.

OBJECTIVES: To retrospectively compare the long-term functional outcomes of ileal and sigmoid orthotopic bladder replacements after radical cystectomy. METHODS: From 1990 to 2004, 123 male patients underwent orthotopic neobladder reconstruction after cystectomy; 75 underwent ileal neobladder (IN) and 48 sigmoid neobladder (SN) procedures. The observation period was 12.3 to 151.6 months (median 61.1). The voiding function of each patient was evaluated at three different observation periods: time 1, less than 5 years; time 2, 5 to 10 years; and time 3, more than 10 years after surgery. RESULTS: Almost every SN patient could void without assistance throughout the observation period. In contrast, the rate of spontaneous voiders was significantly low for the IN patients. Daytime continence was significantly worse in the SN than in the IN patients at time 2 (P <0.01), and the difference in nighttime continence between the two groups was even larger during the first 10 years after surgery (P <0.01). The postvoid residual urinary volume at time 2 was significantly larger in the IN than in the SN patients (P <0.01). No significant change in neobladder capacity was observed for either procedure throughout the observation period. The mean serum creatinine level was stable for both groups throughout the follow-up period. CONCLUSIONS: The IN and SN procedures result in different outcomes. The rate of spontaneous voiders was better in the SN group than in the IN group. The IN tends to provide better continence than the SN. In choosing a neobladder procedure, a proper understanding of the prospects of voiding functions is required.

Importance of specific hydrogen bonds of archaeal rhodopsins for the binding to the transducer protein.

Four rhodopsins, bacteriorhodopsin (bR), halorhodopsin (hR), sensory rhodopsin (sR) and phoborhodopsin (pR) exist in archaeal membranes. bR and hR work as a light-driven ion pump. sR and pR work as a photo-sensor of phototaxis, and form signaling complexes in membranes with their respective cognate transducer proteins HtrI (with sR) and HtrII (with pR), through which light signals are transmitted to the cytoplasm. What is the determining factor(s) of the specific binding to form the complex? Binding of the wild-type or mutated rhodopsins with HtrII was measured by isothermal titration calorimetric analysis (ITC). bR and hR could not bind with HtrII. On the other hand, sR could bind to HtrII, although the dissociation constant (K(D)) was about 100 times larger than that of pR. An X-ray crystallographic structure of the pR/HtrII complex revealed formation of two specific hydrogen bonds whose pairs are Tyr199(pR)/Asn74(HtrII) and Thr189(pR)/Glu43(HtrII)/Ser62(HtrII). To investigate the importance of these hydrogen bonds, the K(D) value for the binding of various mutants of bR, hR, sR and pR with HtrII was estimated by ITC. The K(D) value of T189V(pR)/Y199F(pR), double mutant/HtrII complex, was about 100-fold larger than that of the wild-type pR, whose K(D) value was 0.16 microM. On the other hand, bR and hR double mutants, P200T(bR)/V210Y(bR) and P240T(hR)/F250Y(hR), were able to bind with HtrII. The K(D) value of these complexes was estimated to be 60.1(+/-10.7) microM for bR and to be 29.1(+/-6.1) microM for hR, while the wild-type bR and hR did not bind with HtrII. We concluded that these two specific hydrogen bonds play important roles in the binding between the rhodopsins and transducer protein.

[Renal cell carcinoma metastatic to the base of tongue: a case report].

A 66-year-old male patient underwent left radical nephrectomy for stage III renal cell carcinoma (RCC) two years and eight months previously. He complained of discomfort at his pharynx. An otolaryngeal examination revealed a tumor about 1.3 cm in size at the base of tongue, and the tumor was resected. It was pathologically diagnosed as clear cell carcinoma and as tongue metastasis of RCC. The subsequent appearance of a minute pulmonary metastasis caused the administration of interferon-alpha and interleukin-II. At present, two years after the treatment, neither growth of lung metastasis nor recurrence of tongue tumor are noticed. Tongue metastasis of RCC is rare and its prognosis is poor. This is the 17th case reported in Japan.

Urethral recurrence following neobladder in bladder cancer patients.

Risk factors of urethral recurrence after neobladder in bladder cancer patients were studied. Between 1977 and 2001, 73 patients (male 58, female 15) underwent neobladder as a treatment for bladder cancer. The observation time after cystectomy ranged from 2 to 254 months (median 60.5). Ten (17.2%) of 58 male patients had urethral recurrence and of the 10, 8 patients had multiple bladder cancers including bladder neck. Urethral recurrence was found by macrohematuria, follow-up cystourethroscopy, and inguinal lymph node swelling. Only one who complained of macrohematuria had positive urinary cytology. Of 58 male patients, 5 underwent total nephroureterectomy for renal pelvic or ureteral cancer before radical cystectomy, and 3 of the 5 had urethral recurrence. Two of 10 patients with urethral recurrence died with cancer, and they had renal pelvic or ureteral cancer. The five-year cause specific survival was 83% for patients with urethral recurrence, and 79% for those without urethral recurrence, respectively. Urethral recurrence did not have a significant effect on survival. The patients with multiple bladder cancers including bladder neck, and renal pelvic or ureteral cancer before radical cystectomy, have high risks for urethral recurrence. Urinary cytology has limited value for the detection of urethral recurrence.