Histologic upgrading of prostate cancer occurs frequently over a short period of time: single hospital experiences of radical prostatectomy.

A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2-3 weeks postoperatively and had regular follow-up treatment. The mean age (+/- SD) was 68.75 (+/- 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months).

[Vesicorectal fistula due to pelvic foreign body: a case report].

We report a case of vesicorectal fistula caused by a pelvic foreign body. An 84-year-old woman presented with urinary tract infection and bladder stone. During transurethral lithotripsy, a foreign body was observed in the stone. CT and colonoscopy revealed a vesicorectal fistula due to a foreign body. After continuous bladder washout over a period of one month, resection of the foreign body, fistulectomy, and sigmoidostomy were performed. The foreign body was suspected to be a medical mesh from a sling operation. After the surgery, the patient's course was uneventful. This is the second patient with vesicointestinal fistula due to a foreign body in the Japanese literature.

Poorly differentiated sarcoma of the prostate causing obstructive acute renal failure: a case report.

A 12-year-old boy presented to the Naha Municipal Hospital complaining of back pain. After intravenous pyelography, computed tomography, magnetic resonance imaging, ultrasonography and biopsy, he was suspected to have sarcoma of the prostate and was referred to the University of the Ryukyus Hospital. Acute renal failure of the post renal type was evident, accompanied by minimal hydronephrosis. Emergency hemodialysis and right ureterostomy were performed, as was a transurethral prostate biopsy. The specimen showed a poorly differentiated sarcoma not otherwise classifiable. After recovery from surgery, chemotherapy was attempted over 2 months, but the patient died of tumor 250 days after admission.

[Simultaneous and metachronous pelvic bone metastases from renal cell carcinoma necessitating hemipelvectomy: report of two cases].

Two patients, one with and one without a history of nephrectomy for renal cell carcinoma, presented with lower abdominal pain. One of them, a 49-year-old man, had tumors in the right kidney and the right ischiadic bone. He underwent nephrectomy and pathologic findings showed renal cell carcinoma (tubular type, granular cell subtype, INF-gamma, G2). The other patient, a 33-year-old man with a previous history of left nephrectomy for renal cell carcinoma (tubular type, granular cell subtype, INF-alpha, G2), was found to have a large tumor in the pelvis, extending from the pubic and iliac bones to the hip joint. Both patients underwent embolization of the hypervascular mass using a vascular coil followed by hemipelvectomy under general anesthesia. The pathology reports confirmed bone metastases from renal cell carcinoma. Both patients survived surgery and their postoperative courses were uneventful without urinary or bowel incontinence. However, impaired potency was noted in the latter case. Immunotherapy with INF-alpha was resumed immediately after surgery.

[Fornix of vagina suspension for cystocele].

OBJECTIVE: Bladder neck hypermobility causes cystocele in middle to old elderly women. We developed an easy and useful surgical technique for cystocele. METHODS: Thirteen patients with cystocele (grade 2-4) were operated by fornix of the vagina suspension. Patients were placed on lithotomy position under general or spinal anesthesia. Lower midline or lower abdominal transverse incision was made to open the peritoneum and denuded vesicouterine pouch. Several nylon sutures were placed on the lateral side of exposed fornix of the vagina. These sutures were suspended to anterior layer of the rectus sheath. Fornix of the vagina was fixed to the rectus muscle, so the prolapsed bladder wall was pulled up in normal position. RESULTS: Operating time ranged from 15-110 minutes (average 73 minutes). Ten patients of thirteen were successful up to 2-43 months postoperatively. Cystocele recurred in three patients of thirteen. Two patients was re-operated by the same method, but one of them recurred. Two of three recurrent patients had grade 4 cystocele. CONCLUSION: Fornix of the vagina suspension for cystocele seems useful and promising because of easy procedure without serious morbidity, especially in elderly high-risk patients.

[Hypogonadotropic hypogonadism treated with HCG monotherapy: report of 3 cases].

We report 3 cases of hypogonadotropic hypogonadism and the effects of human chorionic gonadotropin (HCG) monotherapy on plasma testosterone levels, which were related to clinical results. The patients were males 29, 21 and 14 years old. Each received 5,000 units of HCG subcutaneously or intramuscularly twice or three times a week for 16 to 40 months. Genital effects, including an increase in testicular volume were seen in all patients after 2 or 3 months. The increase in plasma testosterone level after HCG therapy was significantly correlated with the genital effects similarly to other treatments. Moreover, spermatozoa appeared in one case.

[Primary carcinoma of the female urethra: report of five cases].

Between 1988 and 1996, we treated five patients with primary carcinoma of the female urethra between 65 and 79 years of age. Presenting symptoms included a urethral mass in 2 patients, hematuria in 1, dysuria in 1 and urethral bleeding in 1. Histopathology revealed squamous cell carcinoma in 4 cases and transitional cell carcinoma in 1. Clinical stage according to Grabstald's classification comprised Stage A in two cases, Stages B, C and D in one each. The modes of treatment were surgical resection alone in two, radiation therapy alone in two, and surgery with adjuvant chemotherapy in one case. Three patients without disease and two with disease are olive from 5 to 87 months after diagnosis.

Thy.1lowCD3- cells sorted from nylon wool-passed bone marrow cells can augment the H-2 identical but not non-identical cytotoxic T lymphocyte precursors in mixed lymphocyte cultures.

Thy.1lowCD3- cells obtained from nylon wool-passed murine bone marrow (NW-BM) cells by cell sorting did not express CD4, CD8, or T cell receptor-alpha/beta and -gamma/delta on their cell surfaces. An extremely limited number of B10.BR (H-2k) responder lymph node (LN) cells were stimulated with B10.D2 (H-2d) stimulator spleen cells in cultures containing the minimum required dose of rat T cell growth factor (TCGF). In these cultures, the generation of cytotoxic T lymphocytes (CTL) was very low. B10.BR Thy.1lowCD3- NW-BM cells, added to these cultures, could augment the CTL generation vigorously, but neither B10 (H-2b) nor B10.D2 cells could. When B10 LN cells were used as responder cells in these cultures, B10 Thy.1lowCD3- NW-BM cells could augment the CTL generation, but neither B10.BR nor B10.D2 cells could. Similar findings were obtained when Lyt-2+ cells or Thy.1+L3T4- (CTL precursor) cells sorted from spleen cells were used as responder cells. Both elements, rat-TCGF and Thy.1low CD3- NW-BM cells, were essential for this augmentation of the CTL generation in this culture system because neither one alone could augment generation, and rat-TCGF could be replaced by Thy.1+ Lyt-2- helper T (Th) cells sorted from spleen cells. These findings showed that NW-BM cells could augment CTL precursors in a self-major histocompatibility complex (self-MHC)-antigen restricted manner, and further that both NW-BM cells and Th cells had different and independent functions to induce CTL.