Rupture of pararenal pseudocyst in a patient with Down's syndrome.

A rare case of Down's syndrome with spontaneous rupture of a pararenal pseudocyst has been reported. The rupture of the pararenal pseudocyst was treated nonsurgically. The presence of this cyst in conjunction with Down's syndrome may be due, in part, to muscular hypotonia.

[M-VAC chemotherapy for patients with lymph node metastases and/or locally advanced bladder carcinoma].

Sixteen patients with lymph nodes metastases and/or locally advanced bladder carcinoma were treated with a combination chemotherapy regimen consisting of methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) from November 1986 through September 1988. There were 14 men and 2 women. The median age was 61.9 years, with a range from 43 to 81 years. Complete response (CR) was observed in 6 of 16 patients (38%), partial response (PR) was confirmed in 5 of 16 patients (31%), and overall response rate was 69%. Median duration of response was 10.3 and 5.2 months in CR and PR patients, respectively. The myelosuppression with this regimen was tolerable. This study demonstrates that the M-VAC regimen is effective in the invasive bladder carcinoma with or without lymph nodes metastases. However, the duration of response is relatively short, and the true long-term benefits of this regimen remain to be determined.

[M-VAC (methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy in advanced renal pelvic and ureteral carcinoma].

Seventeen patients with advanced renal pelvic and ureteral carcinoma receiving M-VAC chemotherapy were evaluated. There were 10 men and 7 women ranging in age from forty-two to seventy-eight years with a mean of sixty-six years. The primary sites of carcinoma were renal pelvis in 4 patients, ureter in 12, renal pelvis and ureter in 1. Fifteen patients had transitional cell carcinoma, one patient had transitional cell carcinoma mixed with squamous cell carcinoma and the histology of one patient was not identified. The median number of treatment cycles was 2.6, ranging from 1 to 6. Significant remissions following the treatment were observed in 5 of 8 primary lesions, 6 of 11 lymph nodes, 2 of 3 lung lesions and 2 of 5 bone lesions, respectively. However, the responses were not seen in 4 liver lesions. Two patients achieved a complete response (CR), 7 had a partial response (PR), 6 had stabilization of their disease, 2 had progressed, and the overall response rate was 52.9%. Two CR patients remain free of disease. Relapse or recurrence was seen in 4 of the 7 patients who achieved PR, and the median duration of response was 6.4 months. While the myelosuppression with this regimen was tolerable, the decreases of white blood cell and platelets count were significant in patients who had undergone prior irradiation. These results indicate that the M-VAC regimen is effective in patients with advanced upper urothelial malignancy. Further, a short response and a poor effectiveness in the metastases of liver and bone remain to be overcome.

[Clinical effects of terodiline hydrochloride for urinary frequency and sense of residual urine].

The clinical effects of terodiline hydrochloride were evaluated in forty-four patients with urinary frequency and/or sense of residual urine. After a four-week treatment with 24 mg terodiline hydrochloride once daily, subjective symptoms were improved and micturition frequency was decreased significantly. Slight dysuria was reported as a side effect only in one patient. Terodiline hydrochloride is considered to be superiorly effective and safe for the treatment of urinary frequency and sense of residual urine.

[Clinical studies of antimicrobial prophylaxis of recurrent urinary infection in women. Long-term, low-dose pipemidic acid for prophylaxis].

The prophylactic efficacy of long-term, low-dose antimicrobial treatment in urinary tract infection (UTI) was studied. Fifty-eight female adult patients with a history of at least two recurrent episodes of UTI in the past year were entered into this study, and the prophylactic regimen was not started until the existing UTI had been eradicated. Patients took 250 mg of pipemidic acid (PPA) daily at bedtime after voiding for 6 consecutive months. Incidence of recurrence of UTI in 48 patients with uncomplicated UTI and 10 patients with complicated UTI decreased to 0.15 and 0.29 per year, respectively, during the treatment compared with 3.5 per year before the treatment. At the end of the 6 months of prophylactic treatment, the patients were divided into two groups by the envelope method. Seventeen patients were treated for a further 6 months and 11 patients were followed up without further medication. Prophylactic efficacy of UTI was obtained in both groups, and there was no significant difference in the incidence of recurrence between the two groups. These findings suggest that the 6-month period of prophylaxis might be sufficient. Examination of the periurethral swab showed that E. coli and Klebsiella sp. were decreased during the treatment. This prophylactic treatment produced no resistant strains. Urinary levels of PPA in the morning urine of patients administered 250 mg of PPA at bedtime averaged 513 micrograms/ml. These values were about 2 times higher than those found in the evening urine after administration of the same dose in the morning.