[A case of solitary bone metastasis of testicular seminoma 6 years post orchiectomy].

A 40-year-old man visited our hospital in August, 2007 with the complaint of gait disturbance. Six years ago he had had right high orchiectomy for treatment of stage I seminoma at another hospital. The magnetic resonance imaging (MRI) examination showed a small tumor and compression fracture in the eighth thoracic vertebrae. Emergency spinal decompression with bone biopsy was done. The pathological diagnosis of the bone was metastasis of seminoma. He was treated with 3 courses of BEP (bleomycin, etoposide and cisplatin) therapy and external beam radiotherapy (36 Gy) was performed. His symptom of gait disturbance disappeared gradually, and was evaluated to be in complete remission. He has been alive with no evidence of recurrence for 3 years.

Values of Doppler sonography predicts high risk variceal bleeding in patients with viral cirrhosis.

BACKGROUND/AIMS: Gastrointestinal bleeding such as rupture of esophagogastric varices remains one of the leading causes of death in patients with liver cirrhosis. As a critical issue, assessment of the bleeding risk of esophageal varices is extremely important. In the present study, by determining the relationship between several parameters measured by pulsed Doppler sonography and the bleeding risk of esophageal varices assessed by upper endoscopy, we investigated what is the most valuable parameter as a supplement to the bleeding risk. METHODOLOGY: A total of 158 patients with hepatitis virus-infected liver cirrhosis (56 positive for HBs antigen and 102 positive for HCV antibody) were studied. As controls, 171 normal subjects were used. The flow volumes of the portal trunk and the splenic vein, the Congestion Index, and the S/P ratio were measured by pulsed Doppler sonography. Based on upper endoscopic findings, we classified the patients into two groups based on bleeding risk of esophageal varices: high-risk and low-risk. Logistic regression analysis was employed to identify the most valuable parameter as a supplement to the bleeding risk. RESULTS: The flow volume of the splenic vein, the Congestion Index, and the S/P ratio in cirrhotic patients with esophageal varices were significantly higher than those in normal subjects (P = 0.000). The mean flow volumes of the portal trunk and splenic vein and the mean of the S/P ratio in the high-risk group for bleeding of esophageal varices were significantly higher than those in the low-risk group (P = 0.000-0.005). Based on logistic regression analysis, the flow volume of the splenic vein was found to be the most valuable parameter for bleeding risk (P < 0.001). CONCLUSIONS: The flow volume of splenic vein with pulsed Doppler sonography was the most valuable parameter for the bleeding risk of esophageal varices.