Retroperitoneal fibrosis and immune-complex glomerulonephritis.

A 63-year-old man with rapidly progressive glomerulonephritis of the immune-complex type showed typical findings of idiopathic retroperitoneal fibrosis involving the left ureter resulting in hydronephrosis. Treatment with steroid improved both conditions. Our case and previously reported cases showing the same association of conditions support the hypothesis that the association is not fortuitous but reflects a common immunological mechanism.

[Prognostic factors of renal cell carcinoma: a multivariate analysis].

In a series of 104 patients with renal cell carcinoma, a variety of clinical and histological factors were analyzed to establish their value as prognostic factors. In a univariate analysis (log-rank test), the presence or absence of symptoms, tumor size, pT, N, M, pV categories, TNM stage, Robson stage, nuclear grade and cell type were significantly associated with cause-specific survival, while age, sex and tumor side were not. In a multivariate analysis using Cox's proportional hazard model of 73 informative cases, only N (0 vs. 1-3) and M (0 vs. 1) categories of stage and nuclear grade (1-2 vs. 3) proved to be independent prognostic markers.

[Magnetic resonance imaging for the evaluation of prostate cancer metastatic to bone].

The response of bone metastatic lesions to endocrine therapy was assessed by repeated magnetic resonance imaging (MRI) and an isotope bone scan after an average period of 7.0 months (2-10 months) in 12 patients with prostate cancer. MRI used both T1-weighted spin echo technique and short TI IR (STIR) sequence. Of 7 patients with hormone-dependent cancer, the bone metastatic lesions resolved or became vague in all patients on STIR image, while in only 4 and 3 on T1-weighted image and bone scan, respectively. Of 5 patients with hormone-refractory cancer, the lesions progressed on both MRI and bone scan in all patients except one who had initially had diffusely metastatic lesions of systemic bone. The results indicate that STIR image of MRI is helpful for the therapeutic evaluation of bone lesions.

[Pelvic kidney associated with staghorn calculus and renal pelvic cancer: a case report].

A 63-year-old man was admitted to our hospital with complaints of right lower abdominal pain and stone excretions. The patient was diagnosed as having a pelvic kidney associated with staghorn calculus and extended pyelolithotomy was to be performed. However, during the operation, a papillary tumor was found in the renal pelvis occupied with staghorn calculus. As the pathological examination of its frozen section was low grade transitional cell carcinoma, nephro-ureterectomy was performed. Pelvic kidney associated with staghorn calculus or renal pelvic tumor with stones is not rare, but pelvic kidney associated with staghorn calculus and renal pelvic cancer is extremely rare.

Magnetic resonance imaging for the diagnosis of prostate cancer metastatic to bone.

OBJECTIVE: To examine the role of magnetic resonance imaging (MRI) in the evaluation of osseous metastasis in patients with prostate cancer. PATIENTS AND METHODS: A series of 36 patients with known prostate cancer, who were undergoing MRI and an isotope bone scan, were studied. RESULTS: Of 19 positive bone scans, MRI was read as negative for metastasis in one. Of eight equivocal scans, two MR images were interpreted as positive and six as negative. Of nine negative scans MRI was positive in one. Further MRI demonstrated additional metastatic lesions that were not shown by bone scintigraphy in six patients. MRI clearly indicated the areas of spinal cord compression in five patients with spinal metastases and associated myelopathy. CONCLUSION: MRI is helpful in the diagnosis of metastatic prostate cancer, especially when other radiographic examinations are inconclusive or spinal cord compression is suspected.

[Benign hemorrhagic renal cyst mimicking cystic renal cell carcinoma].

We experienced four cases of benign hemorrhagic renal cyst which were indistinguishable from cystic renal cell carcinoma on ultrasonography, computer tomographic scanning, magnetic resonance imaging and angiography. Nephrectomy was performed in one case and enucleation of the mass in the other three. Pathological diagnoses were hemorrhagic septate cyst in two cases, cyst with inflammation containing old blood clots in one, and organized hemorrhagic cyst with calcification in one. Conservative surgeries should be considered when the definite diagnosis for renal hemorrhagic cysts is not made.

[Acute respiratory failure resulting from diffuse microscopic pulmonary tumor emboli by bladder cancer: a case diagnosed at autopsy].

A 71-year-old man who had undergone a total cystectomy and a transureterocutaneostomy more than a year earlier was admitted to our hospital on February, 1992 because of the chief complaints of anorexia and systemic bone pain due to multiple bone metastases of bladder cancer. At two weeks after the admission, he had a sudden attack of dyspnea. His chest reontgenogram revealed no significant abnormalities. He had repeated attacks and died of respiratory failure two days after the first attack. An autopsy disclosed diffuse microscopic pulmonary tumor emboli in the pulmonary arteries and arterioles of bilateral lungs, but there was no parenchymal metastasis. The metastatic lesions in the sinusoids of the liver were also occupied by numerous tumor emboli, suggesting that the tumor emboli in the lungs had derived from those in the sinusoids. Microembolization of the whole lung area must be considered as a cause of clinically unexplained dyspnea.

[Adjuvant chemotherapy for invasive bladder cancer. Multicenter study].

During 2 years and 10 months from November 1985 to September 1988, 50 patients with invasive bladder cancer (pT2-4, pN0-2, M0) were treated with total cystectomy followed by adjuvant combination chemotherapy including cis-platinum. In addition, so-called immunopotentiator (OK-432) and Kanpo (Juzentaihoto: TJ-48) were given to the patients in a random fashion to evaluate whether or not these agents had any significant effect on patients' prognosis. The 3- and 5-year survival rates for 48 evaluable patients were 71% and 67%, respectively. Histologic grade of primary tumors and number of cycles of adjuvant chemotherapy administered had a significant correlation to patients' survival: patients with grade 2 anaplasia had a better 3- and 5-year survival rates than those with grade 3 anaplasia, and patients receiving 3 or more cycles of chemotherapy had a better 3-year survival rate than those with 2 or less cycles. pT and pN categories also affected patients' survival, though not statistically significant. Administration of OK-432 or TJ-48 and pre-operative treatment such as irradiation and intra-arterial chemotherapy had no favourable effects on the survival. Side effects of the adjuvant chemotherapy were minimal to moderate and more than 70% of the patients tolerated at least 3 cycles of chemotherapy. It is likely that adjuvant chemotherapy, when given in a post-operative setting, should be repeated at least 3 cycles or more.

[The clinical study of 23 cases in patients with bladder cancer over 85 years old].

We treated 23 patients with bladder cancer over 85 years old. The male to female ratio was 3.6. Six cases (26%) were of low grade (G1) cancer and 16 (70%) were of high grade (G2, G3), and the other one was of unknown grade. Superficial cancer (less than or equal to pT1) was seen in 11 cases (48%), and invasive cancer (greater than or equal to pT2) was 12 cases (52%). The 3-year survival rate was 38% for all, that for superficial cancer 55%, and that for invasive cancer 0%. Fifteen cases (65%) were treated by TUR and the prognosis of invasive cases in this group was poor.

[Prophylactic intravesical chemotherapy in bladder tumors after surgery of upper tract urothelial carcinoma].

Sixteen patients with upper tract urothelial carcinoma underwent intravesical chemotherapy usually at 2 week intervals in the first year and at 4 week intervals in the second year after nephrouretectomy. For bladder instillation 10 mg mitomycin C in 20 ml saline was used on 7 patients, 5 mg carboquone and 100 mg cytosine arabinoside in 40 ml saline on 5 patients and 30 mg adriamycin in 40 ml saline on 4 patients. Two (12.5%) of the 16 patients developed bladder tumors within 2 years after surgery, but 11 (42.3%) of the 26 patients with upper tract urothelial carcinoma who did not receive intravesical chemotherapy suffered from bladder tumor within 2 years after surgery. Prophylactic intravesical chemotherapy reduced significantly (p less than 0.1) the incidence of bladder tumor after the surgery of renal pelvic and ureteral tumors.

[Antiemetic therapy with timiperone in cisplatin-induced vomiting].

A new neuroleptic drug, Timiperone, is able to exert an antiapomorphine effect at doses smaller than cataleptogenic doses. Nineteen patients with urologic malignancy undergoing chemotherapy with cisplatin in combination with other agents were studied for the antiemetic efficacy of Timiperone. Six of 8 patients over 46 years old treated with Timiperone 6 mg/day p.o. from the day before undergoing DDP therapy to the last day of the therapy had no episode of vomiting and 2 patients had a few episodes of emesis (one and two episodes during 5 days of undergoing DDP, respectively). Five patients under 45 years old given Timiperone 6 mg/day by the same method had few episodes of vomiting, but suffered from extrapyramidal symptoms. Finally 6 patients undergoing DDP with Timiperone in combination with trihexyphenidyl suffered no symptoms of catalepsy but sometimes had mild vomiting episodes (1-4 times a day). We would like to propose that in antiemetic therapy with Timiperone for cisplatin-induced nausea and vomiting, a dose of 4.5 mg/day be given from two days before undergoing chemotherapy because of the cumulative effect of Timiperone.

[Effects of long-term administration of Tegafur on patients with relapsing advanced carcinoma (stage D) of the prostate].

Daily 600 mg of Tegafur, in addition to antiandrogen therapy, was administered to 20 patients with relapsing prostatic carcinoma at stage D. Thirteen of the patients died and 7 patients are still alive. These patients were evaluated according to the objective response criteria of NPCP . Three patients showed partial regression, 9 patients showed stable prognosis and 8 patients showed progression. The patients who died had a mean survival duration of 77 weeks, which is longer than in other reports on the treatment of relapsing prostatic carcinoma. No severe toxicity was observed in any of the patients. These findings suggest that Tegafur is effective for the treatment of relapsing prostatic carcinoma.

A clinico-pathological survey of exophytic tumors of the urinary bladder. I. An analysis of the structure of the fibro-vascular cores with special references to the clinical prognosis.

In this paper the results of the clinicopathological study on a total of 79 bladder tumor cases are presented. They are principally related to the stromal proliferation or branching of the tumors. The tumor cases consist of those with a good prognosis as well as those with a poor prognosis. In the former category there are 61 cases with a long survival history (with or without recurrence); the remainder (18 cases) had a history of a short survival (dying within 2 years). Histologically there was a marked difference in the regularity of the stromal branching of the tumor between those cases with a long survival history and those cases with a short survival history. In the former group the regular type of stromal branching was predominant; in the latter group the irregular type was predominant.