[Surgical removal of renal cell carcinoma after partial splenic embolization in a patient with liver cirrhosis: a case report].

Partial splenic embolization is used to treat patients with liver cirrhosis accompanied by hypersplenism for improving thrombocytopenia and leukopenia. We report a case in which partial splenic embolization was used before nephrectomy because both renal cell carcinoma and liver cirrhosis were present. A 75-year-old woman visited our hospital complaining of abdominal distension. Computed tomography revealed a 5.5 cm left renal tumor. Liver cirrhosis, ascitis, splenomegaly was observed. Blood tests revealed pancytopenia; platelet count was 2.9 x 10(4)/mm3. The patient was treated by partial splenic embolization in an attempt to ensure a safe nephrectomy. After the embolization, her platelet count increased immediately to 19.2 x 10(4)/mm3, and left nephrectomy was performed successfully.

[Surgical removal of retroperitoneal liposarcoma after transarterial embolization: a case report].

A case of retroperitoneal liposarcoma that was removed after transarterial embolization is reported. A 62-year-old man was admitted with body weight loss and general fatigue. Computed tomography revealed an extrarenal tumor, 27 x 17 x 11 cm in size, in the left retroperitoneal space. Arteriography revealed that the hypervascular tumor was fed from the left renal artery, the left adrenal artery and the left lumber arteries (L1-L4). At first the patient underwent transarterial embolization of the left renal artery and the left lumbar arteries (L1, L3, L4). Twenty-two days later he underwent surgical excision of the tumor with combined resection of the left kidney and the descending colon. The resected tissue weighed 2,500 g. Histological examination revealed liposarcoma, pleomorphic type. His postoperative course was uneventful, and he has remained free of disease for 15 months.

[Clinical analysis on 40 cases of primary aldosteronism--long-term follow-up of blood pressure].

Forty cases of primary aldosteronism after adrenalectomy were observed from 1975 to 1993 at Yokohama City University hospital. All of them had adrenocortical adenoma producing aldosterone. These cases are evaluated retrospectively on localization, surgical approach and long term follow up blood pressure. These patients were from 26 to 65 years old (average 46.6), and consisted of 11 males and 29 females. Fourteen adenomas were located on the right adrenal gland, 25 on left, and one case had adenomas on bilateral adrenal glands. On localization study, 39 cases had been correctly diagnosed by combined diagnostic method of selective adrenal venous sampling, selective adrenal venography, adrenal scintigraphy, X-ray CT, and MRI, with each diagnostic values being 65.8%, 69.0%, 72.5%, 96.9%, 100% respectively. This analysis suggests that, in almost cases, it is enough to diagnose the laterality by adrenal scintigraphy, X-ray CT and MRI. Selective venous catheterization is not always necessary to know the laterality of the tumor. For surgical approach to the adrenal gland, 16 adenomas were removed through anterior subcostal incision (transabdominal approach) from 1975 to 1988, and 24 cases through lumbar oblique incision or dorsal incision (extra peritoneal approach) from 1986 to 1993. This analysis reveals that lumbar oblique and dorsal incision provided us superior surgical approach to the adrenal gland. Thirty-eight cases had been followed after adrenalectomy for more than one year (average 57.6 months). Blood pressure had been normalized in 28 cases, but 10 cases had remained hypertensive.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of sepsis caused by methicillin-resistant Staphylococcus aureus aureus (MRSA) following retropubic prostatectomy].

Although severe infection caused by methicillin-resistant Staphylococcus aureus (MRSA) has become a serious social problem in medical facilities, it is relatively uncommon in the urological field. It is supposed that MRSA in the urine is asymptomatic and MRSA urinary colonization is not likely to occur compared with the other Staphylococci. We report a case of sepsis caused by MRSA that occurred in the patient following retropubic prostatectomy. He had had a urinary catheter indwelt and had received anti-bacterial agents before the operation. Factors such as the continuing use of antibiotics and urinary catheterization could contribute to MRSA infections especially following open surgery. Therefore careful management seems important for such patients.

[M-VAC chemotherapy for advanced urothelial cancer--side effects and their management].

Since the M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) regimen was reported by Sternberg in 1985, it has been widely accepted for the treatment of metastatic transitional cell carcinoma. This regimen has a significantly high response rate, but bone marrow suppression and gastrointestinal (GI) symptoms are inevitable. To complete this M-VAC regimen, preventive therapy for side effects is necessary. From November 1986 to March 1993, a total of 72 patients were admitted and received M-VAC therapy at our hospital. All of them had metastatic or invasive transitional cell carcinoma and they received a total of 163 complete courses of M-VAC therapy. We examined the side effects of this M-VAC regimen, and evaluated the effectiveness of colony-stimulating factor for prevention of granulocytopenia or granisetron for prevention of GI symptoms. Twenty-three patients (39 courses) were given recombinant colony-stimulating factor. This cytokine prevented the nadir of neutropenia and shortened the period to reach the nadir and period that the neutrophil count was below 1,000/mm3. Twelve patients (26 courses) were given granisetron, with significant reduction of the incidence of GI symptoms. These findings suggest that M-VAC therapy is effective and safe when used in combination with these drugs.

[A study on reservoir function of Kock pouch during a 3-year postoperative period].

Kock continent ileal reservoir has been one of the major options of urinary diversion for the patients with bladder cancer. We performed Kock pouch operation in 16 patients (male 12, female 4; from 41 to 66 years old, mean age 57 years old). Since the reservoir function of Kock pouch after a long postoperative period is not well known, we examined the volume capacity, the compliance and the length of efferent valve of Kock pouch in 8 patients during a 3-year postoperative period. Although the compliance was stable, the volume capacity and the length of the efferent valve showed a decreasing tendency. The shorter efferent valve was not always associated with the case of urinary incontinence. Most of the complications in 15 patients was trouble of efferent valve (prolapse of efferent valve in 7 cases and eversion or fistula formation that required reconstruction surgery in 3 cases). Although some complications were observed, the reservoir function of the pouch was stable. Therefore this method is reliable for permanent urinary diversion.

[Clinical observations on bladder cancer--difference in clinical features with age].

Three hundred and ninety-four patients with transitional cell carcinoma of the bladder who initially visited Yokohama City University Hospital were reviewed according to age group. The patients were divided into four groups, group A (less than 49 years old), group B (from 50 to 64 years old), group C (from 65 to 79 years old) and group D (more than 80 years old). The clinical characteristics as follows were obtained by statistical analysis compared with these four groups. No statistical significance was obtained about frequency of macroscopic hematuria as chief complaint. However, the younger age groups (A and B) tended to visit hospital later after the first symptom of hematuria. The older age groups (C and D) had multiple and large tumor at the first cystoscopic examination. The older age groups (C and D) had high stage and high grade tumor at the first roentgenological examination and transurethral biopsy or resection. The 5-year recurrence free rate after transurethral resection of bladder tumor (TUR-BT) of the older age group (D group) was lower than that of the other groups. The 5-year survival rate of older age group was lower than that of the younger age group. However, no statistical significance between the age groups existed concerning high grade or high stage tumor and survival after total cystectomy. We clarified here that the clinical features of elderly patients who have bladder cancer were significantly different from those of younger patients. Otherwise the prognosis of patients who have high grade and/or high stage bladder cancer were demonstrated to be poor regardless of age.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant lymphoma of the prostate--a case report].

We report a case of prostatic malignant lymphoma causing bilateral hydronephrosis. A 73-year-old man was referred to our department, suffering from urinary frequency and gross hematuria. The mild elevation of serum prostatic tumor markers made us suspect prostatic carcinoma. He was admitted to our hospital and needle biopsy of the prostate was performed. Unexpectedly histological findings revealed "malignant lymphoma, diffuse large cell type". CT scan showed bilateral hydronephrosis, and renal function was decreased. As the patient suddenly vomited blood, gastric fiberscopy and biopsy was performed. Histological diagnosis of stomach was the same as for the prostate. After systemic chemotherapy of cyclophosphamide, adriamycin, vincristine, prednisone (CHOP) regimen, renal function improved and the tumor of stomach reduced, but his respiratory condition rapidly worsened, and he died about 1 month after chemotherapy. Malignant lymphoma involving the prostate is very rare. Especially in Japan only 19 cases have been reported including our case. Four of the 19 men were in their twenties and so we remind the urologists of the possibility of "malignant lymphoma of the prostate" in young patients with dysuria or frequency.

[Pedunculated hepatocellular carcinoma suspected of right adrenal tumor: a case report].

We report a rare case of extrahepatic growing hepatocellular carcinoma which was clinically diagnosed as right adrenal tumor. A 61-year-old woman was admitted for further examination of right flank pain and hypertension. Abdominal computed tomographic scan and echogram revealed a suprarenal mass. Hypercatecholaminemia was suspected from urinary analysis. Preoperative diagnosis was right adrenal tumor; suspected pheochromocytoma. On operation, we found the tumor was pedunculated from right lobe of liver and compressing normal right adrenal gland. Its clinical diagnosis was hepatocellular carcinoma. Ten months after operation she is still alive. We discuss the difficulty of differential diagnosis between extrahepatic growing hepatocellular carcinoma and adrenal tumor.

[Clinical analysis of 46 cases of radiation cystitis].

We experienced 46 cases of radiation cystitis between 1973 and 1990, 10 of which showed intractable bleeding and 17 recurrent bleeding. We clinically analyzed these cases to determine the factors responsible for intractable and recurrent bleeding. Intractable bleeding was suggested to related to the aggravation of the local condition of the urinary tract and recurrent bleeding with an increase of complications, especially diabetes mellitus and hypertension. In conclusion, long-term follow up of local conditions and complications is important in the prevention of intractable and recurrent bleeding of radiation cystitis.

Morphological and neoplastic transformation of C3H/10T1/2 Cl 8 mouse embryo cells by insoluble carcinogenic nickel compounds.

We studied induction of cytotoxicity and morphological transformation in C3H/10T1/2 Cl 8 (10T1/2) mouse embryo fibroblasts by soluble and insoluble carcinogenic nickel compounds. Soluble nickel sulfate and nickel chloride caused dose-dependent cytotoxicity in the concentration range from 0.5 microM to 100 microM after 48 hr treatments, but neither compound induced morphological transformation even at concentrations causing up to 94% cytotoxicity. Insoluble nickel subsulfide, nickel monosulfide, and nickel oxide caused dose-dependent cytotoxicity and a low, dose-dependent frequency of morphological transformation in the concentration ranges from 0.5 to 40 microM, 5 to 50 microM, and 50 to 400 microM, respectively, after 48 hr exposure of cells to these compounds. Foci were predominantly of type II morphology; type III foci were rare. The insoluble nickel compounds studied caused no induction of base substitution mutations to ouabain resistance in 10T1/2 cells over concentration ranges that induced morphological transformation. Nickel subsulfide and nickel monosulfide were taken into cells by phagocytosis, since particles were visible in intracytoplasmic vacuoles. Numerous nickel oxide particles were found associated with cells, but true phagocytic uptake was difficult to detect since no vacuoles were observed. We twice cloned type II and type III foci induced by insoluble nickel compounds, established independent cell lines, and characterized their phenotypes. Four of seven of these cell lines had three- to fourfold increased saturation densities compared to 10T1/2 cells, formed type II and type III foci in reconstruction assays, and grew in soft agarose. One cell line induced by nickel oxide formed tumors in nude mice. These data indicate that insoluble carcinogenic nickel compounds induced type II foci in 10T1/2 cells, some of which were tumorigenic, and that the 10T1/2 cell system is suitable for studying mechanisms of nickel compound-induced morphological transformation in mammalian cells.

[A case of hemangiopericytoma in the retroperitoneal cavity and a review of literature in Japan].

A case of hemangiopericytoma in the pelvic retroperitoneum is reported. The patient, a 45-year-old man, visited us with a complaint of sudden urinary retention. Intravenous pyelogram and computerized tomographic scan revealed a large pelvic mass displacing the bladder to the left superiorly. Laparotomy was performed, and biopsy showed the mass to be a malignant hemangiopericytoma. He underwent a surgical excision after receiving irradiation to the true pelvis and embolization of right internal iliac. He developed multiple pulmonary and liver metastases and died 2 years after surgery. Thirty cases of retroperitoneal hemangiopericytoma reported in Japan are reviewed.

[Complete remission of lung metastasis of renal cell carcinoma by (UFT) therapy].

A case of multiple lung metastasis of renal cell carcinoma in which complete remission was obtained with administration of UFT (Tegafur + Uracil) is reported. The patient was a 58-year-old male, who already received right nephrectomy and previous chemotherapy. However, because the chemotherapy was ineffective, UFT was administered orally at a dose of 400 mg every day. Response of the lung lesion was observed 10 weeks after starting (UFT) therapy and complete disappearance of the lesion was obtained 6 months later. The duration of complete response lasted 6 months. This case suggests that UFT could be a useful anticancer drug against advanced renal cell carcinoma.

Preoperative doxorubicin instillation in recurrent superficial bladder cancer.

Further recurrence of superficial bladder cancer after transurethral resection is frequent in patients who have already experienced recurrence. In an attempt to prevent or delay further recurrences in such patients, the effect of preoperative doxorubicin instillation was investigated. A total of 51 patients with recurrent superficial bladder cancer were randomized to receive either TUR alone or TUR with preoperative doxorubicin instillation. Doxorubicin was administered twice a week for 3 weeks before TUR surgery. An objective response (CR + PR) of the tumors was observed at operation in 12 of 25 (48%) evaluable doxorubicin-treated patients. Chemical cystitis was seen in 32% of the patients. Further recurrence after TUR was observed in 13 of 25 (52%) patients in the doxorubicin group, as against 15 of 23 (65%) evaluable patients in the control group. The mean disease-free interval was significantly longer (11.8 as against 7.1 months) in the doxorubicin group. These preliminary results suggest that preoperative doxorubicin instillation might be effective for prolongation of the disease-free interval in patients with recurrent bladder cancer.

A trial of the in vitro sensitivity test of anti-cancer drugs using primary cultured urogenital cancer cells.

An in vitro chemosensitivity test was applied to clinical specimens of urogenital cancer tissues obtained at operation. Incorporation of 3H-leucine into primary cultured cells 24 h after treatment with cytotoxic drugs was used as an index for cell viability. Primary cell culture was performed using specimens obtained from 37 patients including 20 with transitional cell carcinoma, 15 with renal cell carcinoma and 2 with testicular cancer. Primary cell growth was achieved in 27 (73%) out of 37 specimens and 10 were tested for chemosensitivity. Each specimen of the tumor revealed different sensitivity to drugs, and results of quadruplicate tests for each specimen were identical. It was concluded that the present method of measuring incorporation of radioactivity using urogenital cancer cells primarily cultured in microtiter plate is practically applicable to an in vitro chemosensitivity test.

[The efficacy of a tissue adhesive agent (BI 0.022) in urinary tract surgery--application to pyelo- and ureterolithotomy].

To evaluate the effect of a tissue adhesive agent (BI 0.022) on renal pelvic and ureteral surgery, the adhesive was applied for 44 patients with urolithiasis. The conventional suture method was performed in 87 patients as a control. The tissue adhesive is composed of fibrinogen, thrombin, factor XIII, aprotinin and CaCl2. The number of sutures for closure of the incision made on the rental pelvis and the ureter was significantly reduced by the use of the tissue adhesive (p less than 0.01). There was no tendency of increase in urinary leakage following the application of the method in comparison with the control. Furthermore, it was noteworthy that 10 in cases with less than a 1 cm ureteral incision were completely closed by the use of the adhesive agent. This tissue adhesive agent should be valuable for renal pelvic and ureteral surgery as a simple substitute for the conventional suture method.

[Clinical analysis of high grade bladder cancer].

The prognosis and other clinical manifestation of 128 patients with high grade bladder tumor were analyzed. Thirty two percent of the total cases of bladder cancer were high grade bladder cancer and 83% of their tumors were invasive tumor at stage T2 and worse. Urinary cytologies were positive in 88% of these patients. The 5-year survival rate in these patients was 32% and those in T1, T2 T3 and T4 cases were 64.2%, 55.6%, 22.7% and 8.0% respectively. The patients treated with radical (total) cystectomy showed a much better survival rate than the cases treated with TUR or partial cystectomy. These results suggest that high grade bladder cancers tend to be invasive and the patients with high grade bladder cancer would have a poorer prognosis than the patients with other histological grade tumors. Thus, these patients should be treated more aggressively including radical cystectomy than the other cases of bladder cancers.

[Bladder cancer in patients under fifty years of age].

Fifty-five cases of carcinoma of the bladder in the age group under fifty years have been reviewed. Seventy three percent of their tumors were low grade and low stage transitional cell carcinoma. Mainly, TUR was performed on these patients and their five year relative survival rate was 97.6%. The recurrence rate after TUR was 16%.

[Soft agar culture of human prostatic carcinoma--effect of testosterone on the clonal growth of the cells].

Soft agar cultures of human prostatic carcinoma cells obtained from prostates with needle biopsy and metastatic lymph nodes were examined. Colony formation were observed in 2 of the 4 needle biopsy specimens and in 7 of the 10 lymphatic nodes specimens. The plating efficiency was 0.04 to 0.43%. The effect of testosterone on the clonal growth of these cells in soft agar culture was studied. In half of the cases, colony formation was increased by the addition of testosterone. Whereas in the other cases, colony formation was not influenced by the testosterone. Clinically, most of the former cases responded well to the anti-androgen therapy. Neither EGF nor hydrocortisone showed any effect on the colony formation of the prostatic cancer cells in soft agar. These results suggest that primary culture of human prostatic cancer is possible in soft agar medium, and that androgen dependency of these cells can be examined in vitro.