[A case of multiple myeloma with heart failure improved remarkably by chemotherapy alone].

A rare case is reported, in which heart failure in a patient with multiple myeloma without amyloidosis was improved following chemotherapy for the myeloma. The patient, a 50 year-old man, came to our hospital for examination because of anemia and hematuria. He was diagnosed as having an IgG kappa type of myeloma with the relatively rare complication of renal cancer. A chest X-ray revealed cardiomegaly and pulmonary congestion. An echocardiogram revealed an enlarged left ventricle with decreased wall motion. No cardiac amyloid deposits were detected upon endomyocardial biopsy. Chemotherapy for the myeloma which was carried out before the operation for renal cancer was not only effective for control of the myeloma, but also decreased the pulmonary congestion and improved the heart function. It is suggested that the lowering of heart function in this patient was not due to amyloid infiltration as is relatively frequent in heart failure but was due to increased blood viscosity due to the multiple myeloma.

[Malignant fibrous histiocytoma arising from the renal capsule: report of a case].

Malignant fibrous histiocytoma (MFH) is now considered the most common soft tissue sarcoma in adults, but MFH arising from the renal capsule is very rare. A 77-year-old woman was admitted with a painful mass in the left flank region on September 10, 1986. Preoperative diagnosis was hypovascular retroperitoneal tumor in contact with the upper pole of the right kidney. The tumor was removed together with the right kidney on December 18, 1986, and the specimen weighted 640 gm. Histological examination revealed storiform-pleomorphic malignant fibrous histiocytoma. No postoperative adjuvant therapy was carried out. Local recurrence of the disease was found about 9 months after the operation, and the patient died on February 23, 1988. Fifteen cases with MFH arising from the kidney reported in the Japanese literatures are reviewed, and the diagnosis, treatment, prognosis and tumor marker are discussed.

[Evaluation of immunosuppressive acid protein in genitourinary malignant diseases].

Clinical significance of serum immunosuppressive acid protein (IAP) was evaluated on the basis of experience on 55 patients with genitourinary malignant disease and 49 control patients. Although the measurement of serum level of IAP is not good enough to diagnose early stage of cancer, patients with 800 micrograms/ml or more of serum IAP can be suspected to have malignant diseases. With the exception of prostatic cancer, both mean serum level and positive rate of IAP were higher in patients with high stage of disease than in those with low stage. Furthermore, on an individual basis, serum level of IAP was elevated with the progress of malignant tumor and was reduced with effective treatment. Thus, serum IAP is considered as a valuable nonspecific tumor marker in monitoring clinical course of genitourinary malignant diseases except for cancer of the prostate. In patients with advanced prostatic cancer, no definite correlation was seen between serum IAP and stage of disease, histopathological finding or serum prostatic acid phosphatase.

[Malignant lymphoma of the testis: report of two cases and review of the literature].

Two cases of malignant lymphoma arising from the testis are reported. Case 1: A 70-year-old man presented with a painless swelling of the right scrotal contents. Right radical orchiectomy was done and histological examination revealed malignant lymphoma of the testis (diffuse lymphoma, mixed type). Bipedal lymphangiography and CT scan showed metastatic lesion in the right retroperitoneal lymph-nodes. Postoperative irradiation to the inverted Y field encompassing the para-aortic, pelvic and inguinal lymph-nodes bilaterally was given to a total dose of 5,000 rad, and treatment with anti-cancer agents was subsequently started. The patient, however, died of liver failure about 6 months after the operation. Case 2: A 74-year-old man presented with painless right scrotal swelling. Right orchiectomy was performed and the tumor histologically appeared to be anaplastic seminoma. The patient received 3,000 rad of irradiation to the retroperitoneal space. There was no evidence of metastasis, until he developed swelling of the right inguinal lymph-nodes about 5 months after the operation. Afterwards, multiple skin tumors in the legs appeared. Biopsy of the skin lesions showed metastasis of malignant lymphoma (diffuse lymphoma, large cell type). The right testis removed previously was then reviewed in detail, and primary malignant lymphoma of the testis was strongly suggested. The patient responded poorly to additional irradiation or cancer chemotherapy and died about one year and 3 months after the right orchiectomy. A statistical survey was made on 117 cases of malignant lymphoma of the testis reported in Japan and the discussion is focused on the significance of new histological classification in relation to the prognosis.

[Clinical application of PPC for nonspecific chronic prostatitis].

The clinical effectiveness of PPC, amino acid preparation, on nonspecific chronic prostatitis was evaluated by the double-blind test method. A mixture of two pollen extracts which has been widely employed for the treatment of chronic prostatitis was used as a control. Neither antibiotics nor anti-inflammatory drug was administered during the investigation. A total of 76 cases was reported from six facilities but 14 of them were excluded or dropped out. In 32 cases in the PPC group, subjective symptoms such as discomfort after urination, discomfort in the perineal region, pollakisuria, sense of residual urine and dysuria were improved in 50.0 approximately 61.9% and 70.0 approximately 83.3% after 2- and 4-week administrations, respectively. Similar results regarding each subjective symptom were obtained in 30 cases of the control group and there was no significant difference between the two groups. In the overall clinical effectiveness concerning subjective symptoms, the effective rate including excellently, moderately and slightly effective was 81.3% with PPC and 83.3% with control drug. However when the effective rate was limited to excellently and moderately effective, PPC was slightly superior to the control drug (50.5% versus 36.7%). In regard to prostatic tenderness by the digital examination, both PPC and control drug induced relatively good improvement after 2-week administration. The degree of improvement, however, was not increased in the subsequent 2 weeks. Sclerotic change of the prostate was poorly recovered in both groups even after 4-week treatment. Swelling of the prostate was alleviated in 12.5% of the control group after 2 weeks and in 31.8% after 4 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)