[A case of vaginal implantation of transitional cell carcinoma of the bladder].

An 82-year-old female presented with asymptomatic gross hematuria in June 1997. Urethrocystoscopy revealed a multiple papillary tumor of the bladder and posterior urethra. Histology of the punch biopsy specimens of the tumor revealed transitional cell carcinoma (TCC), grade 2 (G2). CT scan showed no distant metastasis and extravesical invasion. The patient was treated by intravesical instillation of adriamycin (ADM), drip infusion of low dose cisplatin (CDDP) and irradiation of the bladder. As the treatment caused a significant tumor shrinkage, transurethral resection of the tumor was performed. Histologically, the tumor revealed no invasion to the muscular layer of the bladder. In April 1998 she noticed genital bleeding, and a multiple papillary tumor was found on the vaginal wall. Histology of punch biopsy specimens of the vaginal tumor showed non-invasive TCC, G2. MRI and specimens of all layer needle biopsy showed no infiltration outside the bladder wall and the vaginal wall. Irradiation of the cavity of the vagina and uterus was made under the diagnosis of superficial vaginal TCC. We assume that vaginal implantation via irrigating fluid or urine has occurred.

[Metachronous bilateral primary malignant lymphoma of the testis: a case report].

A 72-year-old man was referred to our department with the chief complaint of painless swelling of the left scrotum in May 1997. Left high orchiectomy was performed under the diagnosis of primary testicular tumor. Histological findings revealed non-Hodgkin's lymphoma (NHL) of diffuse, mixed type, B cells. No evidence of tumors in any other site was detected by further examinations. About 3 years and a month earlier, he had undergone right high orchiectomy and postoperative radiotherapy (inverted Y irradiation) and chemotherapy (CHOP 5 cycles) for a right testicular tumor whose histological findings were NHL of diffuse, large cell type, B cells. Metachronous bilateral primary malignant lymphoma of the testis is very rare and we discussed each tumor origin by using IgH gene (IgJHDNA) rearrangement as a tumor specific marker of B cell lineage malignant lymphoma. We discussed the clonality of IgJHDNA rearrangement using polymerase chain reaction (PCR) in each paraffin fragment diagnosed pathologically as NHL of B cell origin.

[Outbreak of tuberculosis among middle aged employees in an office].

We experienced an outbreak of tuberculosis in a salesmen's office during the period from 1993 to 1997. The outbreak was detected retrospectively. In July, 1997, a 47-year-old man was diagnosed as pulmonary tuberculosis. As he worked with a 42-year-old man who was already registered in our health center, we suspected an outbreak and started a survey. Contact examinations were carried out for 9 employees of his office and 3 members of his friends. As the result of these examinations, one employee showed strongly positive tuberculin skin test, and was indicated isoniazid chemoprophylaxis. Furthermore, some contacts told us that seven cases of active tuberculosis and three cases of primary infection indicated chemoprophylaxis had occurred among employees and their family members. The index case was a 41-year-old man who was diagnosed as tuberculosis in January, 1993. The second case among employees had previous history of pulmonary tuberculosis. Almost the patients among the employees had a hard life suffering from debts, and had heavy alcohol use. These facts may partly explain the spread of tuberculosis in this office. As each case was registered at different health centers, we hadn't noticed the outbreak for 4 years. But it is true that insufficient approach of health centers to contacts caused a serious delay of detecting the outbreak. A thorough investigation for contacts and complete contact examinations are needed.

Pseudosarcomatous myofibroblastic tumor of the urinary bladder with massive intraperitoneal hemorrhage in a child.

A 3-year-old boy presented with persistent abdominal pain, hematuria and facial pallor with progressive anemia. A computed tomography scan showed a massive intraperitoneal hemorrhage and tumor mass in the bladder. Histological examinations of the resected tumor revealed findings of pseudosarcomatous myofibroblastic tumor (PMT). The clinico-pathological features of this case warn us that PMT can cause acute abdomen syndrome with massive intraperitoneal hemorrhage.

Serum pyridinolines as specific markers of bone resorption in hemodialyzed patients.

Serum levels of hydroxylysyl pyridinoline and lysyl pyridinoline were quantified in uremic patients undergoing maintenance hemodialysis and in healthy subjects. Pre-hemodialysis serum levels of hydroxylysyl pyridinoline and lysyl pyridinoline in the hemodialyzed patients were significantly higher than those in healthy subjects. Serum levels of hydroxylysyl pyridinoline and lysyl pyridinoline decreased significantly after hemodialysis with reduction rates of about 40%. Pre-hemodialysis serum levels of hydroxylysyl pyridinoline and lysyl pyridinoline correlated significantly with intact parathyroid hormone, osteocalcin and bone-specific alkaline phosphatase. Lysyl pyridinoline showed better correlations with these parameters than hydroxylysyl pyridinoline. Parathyroidectomy markedly decreased serum levels of hydroxylysyl pyridinoline and lysyl pyridinoline. These results indicate that serum pyridinolines, especially lysyl pyridinoline, may be used as specific biochemical markers of bone resorption in hemodialyzed patients.

Interleukin 8 and biocompatibility of dialysis membranes.

To determine whether interleukin 8 (IL-8) can be used as an index of biocompatibility of dialysis membranes, the effects of hemodialysis (HD) on plasma IL-8 levels and the expression of IL-8 mRNA in peripheral blood mononuclear cell (PBMC) were compared among regenerated cellulose (RC), polyacrylonitrile (PAN) and polymethylmethacrylate (PMMA) dialyzers. HD using RC dialysers significantly increased plasma IL-8 levels and induced abundant expression of IL-8 mRNA in PBMC. HD using PMMA dialyzers also increased plasma IL-8 levels and induced slight expression of IL-8 mRNA. In contrast, HD using PAN dialyzers neither increased plasma IL-8 levels nor induced the expression of IL-8 mRNA. In vitro studies demonstrated that IL-8 was considerably adsorbed by PAN membranes and not at all by RC and PMMA. These studies indicate that plasma IL-8 level and expression of PBMC IL-8 mRNA can be used as indices of biocompatibility of dialysis membranes.

Effect of hemodialysis on plasma levels of vasoactive peptides: endothelin, calcitonin gene-related peptide and human atrial natriuretic peptide.

To determine the role of vasoactive peptides such as endothelin (ET), calcitonin gene-related peptide (CGRP) and human atrial natriuretic peptide (hANP) in the regulation of blood pressure in uremic patients, and to determine the effect of various types of dialyzer membranes on hemodialysis (HD)-induced changes in plasma levels of such peptides, plasma ET, CGRP and hANP were measured in HD patients and patients on continuous ambulatory peritoneal dialysis (CAPD). Plasma levels of ET, CGRP, and hANP were significantly higher in HD and CAPD patients than in healthy subjects. There were no significant differences in plasma levels of ET, CGRP, and hANP between hypertensive and normotensive HD patients, and no significant correlation was observed between HD-induced changes in plasma levels and changes in blood pressure. Plasma levels of ET decreased when HD was performed using high-flux membranes, such as polyacrylonitrile (PAN), polymethyl methacrylate (PMMA) and cellulose triacetate (CTA), but did not decrease using a saponified cellulose (SC) membrane. Plasma levels of CGRP decreased in the case of PAN, but increased significantly with PMMA and showed no change with SC and CTA. Plasma levels of hANP decreased in all types of dialyzer membranes due to decreased secretion. These results indicate that the effect of HD on plasma levels of ET and CGRP, but not hANP, depends on the type of dialyzer membrane used.

[Endoscopic findings of nipple fixation in Kock pouch].

Fixing the nipple to the pouch wall is indispensable to reduce the incidence of late complications of the Kock pouch. We performed endoscopy of the Kock pouch in 28 patients to evaluate the nipple valve fixation. We carried out submucosal fixation of nipple in 17 patients, fixation using staples in 2 patients and full layer fixation in last 9 patients. On endoscopy, both efferent and afferent nipples were poorly fixed or completely detached in 8 of the 17 patients who underwent submucosal fixation. On the other hand, there were no patients in whom the nipple was poorly fixed or completely detached among the other 11 patients. We experienced nipple malfunction in only one of the last 9 patients. Based on endoscopic findings and clinical results, we concluded that full layer fixation was reliable and useful to reduce the incidence of nipple valve complications.

[A case of adrenal myelolipoma].

A case of adrenal myelolipoma is presented. The patient was a 61-year-old woman who complained of lumbago this time. A tumor of the left adrenal gland, however, had been found by computed tomography 4 years earlier. Judging from the CT, the size of this tumor had not changed at all, although the density of the mass on admission had reduced, compared with that of 4 years earlier. Laboratory examinations of adrenal function was normal. Left adrenalectomy was performed. Histologically, this tumor consisted of adipose and some hematopoietic tissue. We reviewed 43 cases of adrenal myelolipoma resected surgically in Japan.

[Renal artery thrombosis following surgical treatment of chyluria].

A case of segmental renal arterial thrombosis occurring after bilateral surgical stripping and interruption of renal pedicle lymphatics for chyluria is presented. This case showed elevation of serum creatinine (6.6 mg/dl) and lactate dehydrogenase (1131 IU/L) on the 4th day after operation, and on the 14th day, renal scintigraphy with 99 m-Tc diethylenetriamine penta acid acetic showed bilateral marked decrease of glomerular filtration rate. Aortography and selective left renal angiography demonstrated left segmental renal thrombosis, but right renal arteries were intact on the 20th day after operation. Systemic anticoagulation therapy was performed, but left renal function was destroyed completely. Excessive and prolonged retraction of the renal artery with vascular tape may have resulted in this unfortunate complication.

[Metastatic tumor of the spermatic cord from gastric cancer].

A 70-year-old male who had undergone gastrectomy due to gastric cancer 6 years previously visited our department complaining of perineal and bilateral scrotal mass. Biopsy specimen of the perineal mass showed well-differentiated adenocarcinoma. The spermatic cords were resected en bloc with the entire scrotal content, penis and perineal skin. Histological examination of the spermatic cord, epididymis and perineal subcutaneous tissue revealed well differentiated adenocarcinoma similar to that of the lesion resected from the stomach 6 years earlier. The patient was followed for 2 years with no evidence of recurrence. Metastatic tumors of the spermatic cord and epididymis resulting from gastric cancer are rare and 31 cases previously reported in the Japanese literature are reviewed.

[Clinical studies on combination therapy of cephem antibiotics in chronic complicated urinary tract polymicrobial infections due to Pseudomonas aeruginosa and other bacteria].

Patients with chronic complicated urinary tract polymicrobial infections due to Pseudomonas aeruginosa and other bacteria were treated with cefsulodin using cefotiam or cefmenoxime as a concomitant drug. Each drug was given to the patients in daily dose of 1 or 2 g by drip infusion twice a day for 5 to 16 days. The results were as follows: Overall clinical efficacy was excellent in 7 cases (44%), moderate in 6 cases (38%) and poor in 3 cases (19%), the effectiveness rate being 81.3%. Bacteriologically, 38 strains (88.4%) were eradicated, 1 strain decreased and 4 strains unchanged out of the 43 clinical isolates from the patients. No side effects and no abnormalities of laboratory findings were observed.