[PROSTATE CANCER DETECTION ON INITIAL TRANSRECTAL PROSTATE BIOPSY IN RELATION TO PROSTATE-SPECIFIC ANTIGEN LEVELS].

(Objective) The prostate cancer detection rates on initial transrectal ultrasound guided prostate biopsies were investigated and the clinicopathological features of prostate cancer patients were examined. (Methods) A retrospective review was performed. From 2003 to 2015, 2,246 patients received initial prostate biopsy in Tochigi Cancer Center. Prostate cancer detection rates and clinicopathological features of the prostate cancer patients in relation to prostate-specific antigen levels were evaluated. (Results) Of the biopsies, 1,294 cases (57.6%) were diagnosed as prostate cancer. The prostate cancer detection rates were 27.8%, 39.8%, 53.6%, 67.4%, 88.4%, 100% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively. Of all 1,294 cases in prostate cancer, patients rates with the low risk were 0%, 30%, 22%, 0%, 0%, 0% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively. (Conclusions) From the results of the prostate cancer detection rates and the low risk rates, it seems difficult to determine diagnosis and treatment of prostate cancer only with PSA values.

[A case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis].

We report here a case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis. An 89-year-old woman, who had been treated for tuberculous spondylitis and operated for tuberculous mastitis and peritonitis, was transferred to our hospital with high grade fever, lower abdominal pain and vomiting. An enhanced abdominal computed tomography (CT) revealed ascites and hypertrophy of the parietal peritoneum. Puncture and drainage of ascites were performed and revealed that a smear examination of the specimen was positive for acid-fast bacilli (Gaffky 1). Treatment by rifampicin, isoniazid and ethambutol for tuberculous peritonitis was started then halted because of drug-induced liver injury. After recovery of the liver damage improved, anti-tuberculosis drugs (rifampicin and streptomycin) were restarted. However two days after recommencing administration, repeated vomiting occurred. An abdominal X-ray showed intestinal obstruction. An ileus tube was inserted and she was treated conservatively, but her symptoms did not improve. Injection of contrast medium through the ileus tube showed obstruction of the upper jejunum, so open surgery was performed. Disseminated yellowish miliary tubercles were seen on the peritoneum and severe inflammatory adhesions were found between the jejunum and the ileum. After ablation of the adhesions, partial resections of jejunum and ileum were performed. Histological examination confirmed the diagnosis of tuberculous peritonitis.

Urinary levels of hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein as a diagnostic biomarker in patients with bladder cancer.

BACKGROUND: To assess the possibility of hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP) as a biological marker for detecting Bladder cancer (BCa), we examined the expression of HIP/PAP in both BCa specimens and BCa cell lines and measured HIP/PAP levels in urine from patients with BCa. METHODS: HIP/PAP expression in BCa samples was evaluated by western blot analysis, and urinary levels of HIP/PAP in patients with BCa were measured by enzyme-linked immunosorbent assay. Urine samples were collected from 10 healthy volunteers and 109 with benign urological disorders as controls, and from 101 patients who were diagnosed with BCa. RESULTS: HIP/PAP was highly expressed in BCa samples as compared with control bladder. Urinary HIP/PAP concentrations were significantly higher in BCa patients than in controls (median value; 3.184 pg/mL vs. 55.200 pg/mL, P <0.0001, by Mann-Whitney U test). Urinary HIP/PAP levels in BCa patients correlated positively with pathological T stages and progression-risk groups among non-muscle invasive BCa (P = 0.0008, by Kruskal-Wallis test). Regarding the recurrence-risk classifications of non-muscle invasive BCa, the urinary levels of HIP/PAP were significantly higher in the intermediate than in the low risk group (P = 0.0002, by Mann-Whitney U test). Based on a cut-off of 8.5 pg/mL, the ability of urinary HIP/PAP levels to detect BCa had a sensitivity of 80.2%, specificity of 78.2%, positive predictive value (PPV) of 75.7%, and negative predictive value (NPV) of 82.3%. CONCLUSIONS: HIP/PAP was abundantly expressed in BCa, and the urinary levels of HIP/PAP could be a novel and potent biomarker for detection of BCa, and also for predicting the risks of recurrence- and progression-risk of non-muscle invasive BCa. A large scale study will be needed to establish the usefulness of this biomarker.

[A case of bleeding giant gastrointestinal stromal tumor of the stomach who achieved partial response by chemotherapy].

A 80-year-old female was referred to our hospital for hematomesis. An abdominal CT revealed a heterogeneous giant tumor of about 11 cm, rich in vascularity, extending from the gastric fundus, beyond the upper side of the spleen, to the left thoracic diaphragm. Gastroscopy showed a 5 cm submucosal tumor with a visible vessel at the gastric fundus. After biopsy was performed, she was diagnosed with a c-kit-positive gastrointestinal stromal tumor (GIST)of the stomach. Following endoscopic hemostasis for gastric bleeding, imatinib mesilate was administered. The tumor reduced markedly, and vascularity in the tumor was diminished, the visible vessels of the tumor disappeared. For curative resection, total gastrectomy with a distal pancreato -splenectomy and a left diaphgram resection is necessary, but surgery was high-risk for this patient because she was advanced in age. She is now achieving a good partial response without surgery.

Intermediate oncological outcomes of percutaneous radiofrequency ablation for small renal tumors: initial experience.

BACKGROUND: For T1 stage incidental renal cell carcinoma (RCC), partial nephrectomy with or without laparoscopy is widely used on the basis of its nephron- sparing and minimally invasive nature. However, high-risk patients of advanced age, or with cardiovascular events are not often suitable candidates for surgery under general anesthesia. Percutaneous radiofrequency ablation (RFA) for mainly the treatment of these patients reportedly achieves satisfactory outcomes. We evaluated the clinical usefulness of this procedure in our initial cases. PATIENTS AND METHODS: In total, 24 renal tumors in 22 patients who had been diagnosed with T1 stage RCC were treated by percutaneous RFA. A LeVeen Needle (Radiotherapeutics) was used with an RF3000 generator. The overlapping ablation method was applied to these tumors, which were larger than 3 cm or located close to the renal hilus. Dynamic contrast-enhanced computed tomography or magnetic resonance imaging was routinely carried out to evaluate the post-treatment state. RESULTS: Maximum tumor diameters ranged from 1.0 to 4.5 cm (mean=2.4 cm). The follow-up period was 1-61 months (mean=18 months) after RFA treatment. Contrast enhancement completely disappeared immediately after this procedure in 23 tumors, the one exception being a 4.5-cm tumor. The tumor recurrence-free and overall survival rates were 85% and 79%, respectively, at two years after RFA. CONCLUSION: Percutaneous RFA is a feasible option for the treatment of RCCs, particularly for those less than 3 cm in diameter.

Double-Filtration Plasmapheresis plus Interferon-ß for HCV-1b Patients with Non-Sustained Virological Response to Previous Combination Therapy.

BACKGROUND AND AIMS: Double-filtration plasmapheresis (DFPP) together with interferon (IFN) administration produces a substantial reduction in the viral load during the early stages of treatment. METHODS: Based on their responses to previous pegylated IFN and ribavirin (PEG-IFN/RBV) therapy, 20 patients were divided into null virological response (NVR; n = 12) and relapse (n = 8) groups. DFPP was used in combination with IFN-ß/RBV with subsequent administration of PEG-IFN-α2a/RBV therapy (DFPP + IFN-ß/RBV then PEG-IFN/RBV). Early viral dynamics was assessed, focusing especially on complete early virological response (cEVR) associated with sustained virological response. Additionally, the interleukin 28B gene, the IFN/RBV resistance-determining region, the IFN sensitivity-determining region and the core regions were analyzed. RESULTS: Rapid virological response was achieved in 0% (0/12) of NVR and in 75% (6/8) of relapse patients, with a significant difference between the two groups (p = 0.001). Similarly, cEVR was achieved in 8% (1/12) of NVR and in 88% (7/8) of relapse patients, with a significant difference between the two groups (p = 0.037). By multivariate logistic regression analysis, interleukin-28B major was a significant determiner of cEVR (odds ratio = 24.19, p = 0.037). CONCLUSION: DFPP + IFN-ß/RBV then PEG-IFN/RBV therapy is indicated more for relapse than for NVR patients.

[A case of peritoneal serous papillary carcinoma].

A 65-year-old female was admitted to our hospital with abdominal distension. Abdominal CT and MRI revealed massive ascites and an omental cake, but the ovaries were of normal size. After an omentum biopsy was performed during open abdominal surgery, she was diagnosed as peritoneal serous papillary adenocarcinoma. After 6 courses of chemotherapy with paclitaxel and carboplatin, the massive ascites totally disappeared, and a second look operation could be performed. She is still alive with no sign of recurrence.

[Two cases of localized autoimmune pancreatitis that relapsed after surgical treatment].

Since the revision of Clinical Diagnostic Criteria for Autoimmune Pancreatitis (AIP) 2006, many cases of localized AIP have been reported. Localized AIP is often difficult to preoperatively differentiate from pancreatic carcinoma. We present two cases of localized AIP that developing relapse after surgical treatment. Swollen hilar lymph nodes of lung was detected on CT in both two cases. Recently, AIP is thought to be the pancreatic manifestation of an IgG4 related systemic disease, which has been associated with many extrapancreatic lesions. Response to steroid treatment and the detection of extrapancreatic lesions may contribute to provide adequate diagnosis thereby avoiding unnecessary surgery.

Elevated urinary levels and urothelial expression of hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein in patients with interstitial cystitis.

OBJECTIVES: To investigate the pathophysiology of interstitial cystitis (IC), we examined urinary levels and urothelial expression of human orthologue of pancreatitis-associated protein (PAP) III, namely, hepatocarcinoma-intestine-pancreas (HIP)/PAP, in patients with IC. We have previously shown that PAP III is expressed with increased frequency in the bladder urothelium in a rat cystitis model (Takahara Y, et al. J Urol. 2008;179:1603-1609). METHODS: HIP/PAP levels in the urine from patients with IC were measured by enzyme-linked immunosorbent assay, and HIP/PAP expression in the bladder tissues was assessed by immunohistochemical study. RESULTS: The median concentration of urinary HIP/PAP was significantly higher in patients with IC than in controls (13.67 vs 1.86 pg/mL urine, respectively, P <.0001, with Mann-Whitney U test). HIP/PAP immunoreactivity was observed in the urothelium of 88.2% of patients with IC (15/17) and in 5.9% of bladder tissues of controls (1/17). Urinary HIP/PAP levels in patients with IC were positively correlated with urinary frequency and bladder pain (r = 0.429, 0.443) and inversely correlated with mean voided urine volume (r = -0.488). CONCLUSIONS: Urinary HIP/PAP levels were significantly higher in IC patients and the apparent HIP/PAP expression in the bladder urothelium was more frequently observed among IC patients. The involvement of HIP/PAP in the pathophysiology of IC is suggested.

Chronic stress elicits prolonged activation of alpha-MSH secretion and subsequent degeneration of melanotroph.

Prolonged stress affects homeostasis in various organs and induces stress-associated disorders. We examined the cellular changes of pituitary gland under the continuous stress condition using a rat model in which rats were kept in a cage filled with water to a height of 1.5 cm for up to 5 days. Among the pituitary hormone mRNAs, proopiomelanocortin mRNA was up-regulated specifically in the intermediate lobe (IL) of this rat model. Additionally, the peripheral blood levels of alpha-melanocyte stimulating hormone (alpha-MSH), a major product of proopiomelanocortin in IL were increased. The alpha-MSH secreting cells, melanotrophs, showed a markedly developed endoplasmic reticulum and Golgi apparatus in the early phase of the experiment. Subsequent continuous stress caused remarkable dilation of the endoplasmic reticulum, disruption of the Golgi structure, and the degeneration of some melanotrophs. In addition the dopaminergic nerve fibers from hypothalamus were markedly decreased in IL. A dopamine antagonist elicited the similar morphologic changes of melanotroph in normal rat. These findings suggest that prolonged stress suppressed hypothalamus-derived dopamine release in IL, which elicited over-secretion of alpha-MSH from the melanotrophs. The present study also suggests that prolonged hyperactivation of endocrine cells could lead to disorder of secretion mechanisms and eventual degeneration.

Hyperbaric oxygen therapy for interstitial cystitis resistant to conventional treatments.

We treated two cases of interstitial cystitis (IC) that were resistant to some conventional therapies with hyperbaric oxygen (HBO). Both patients underwent 20 sessions of 100% oxygen inhalation (2.0 atmosphere absolute for 60 min/day x 5 days/week for 4 weeks) in a hyperbaric chamber. The period of follow up was 12 months for case 1 and 9 months for case 2. After a course of HBO, the bladder mucosal ulcer (Hunner's ulcer) disappeared, and changes from baseline in pain and urinary frequency was constitutively inhibited. There were no adverse events during the 20 treatment sessions. One woman (case 1) had mild Eustachian tube dysfunction, resulting in a transient hearing impairment. HBO seems to be an option for treatment of IC resistant to conventional therapies.

Role of temperature and hydrochloric acid on the formation of chlorinated hydrocarbons and polycyclic aromatic hydrocarbons during combustion of paraffin powder, polymers, and newspaper.

Formation of chlorinated hydrocarbons and polycyclic aromatic hydrocarbons (PAHs) were determined using a laboratory-scale incinerator when combusting materials at different temperatures, different concentrations of hydrochloric acid (HCl), and when combusting various types of polymers/newspaper. Polychlorobenzenes (PCBz), polychlorophenols (PCPhs), polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) and their toxic equivalency (TEQ) and PAHs were highlighted and reported. Our results imply maximum formation of chlorinated hydrocarbons at 400 degrees C in the following order; PCBz>or=PCPhs>>PCDFs>PCDDs>TEQ on a parts-per-billion level. Similarly, a maximum concentration of chlorinated hydrocarbons was noticed with an HCl concentration at 1000 ppm with the presence of paraffin powder in the following order; PAHs>PCBz>or=PCPhs>>PCDFs>PCDDs>TEQ an a parts-per-billion level. PAHs were not measured at different temperatures. Elevated PAHs were noticed with different HCl concentrations and paraffin powder combustion (range: 27-32 microg/g). While, different polymers and newspaper combusted, nylon and acrylonitrile butadiene styrene (ABS) produced the maximum hydrogen cyanide (HCN) concentration, concentrations of PCDD/FS, dioxin-like polychlorinated biphenyls (DL-PCBs), and TEQ were in a decreasing order: polyvinylchloride (PVC)

[Two cases of spermatic cord leiomyosarcoma].

A 72-year-old man and a 59-year-old man presented with painless hard swelling of left scrotal content. They underwent left high orchiectomy with clinical diagnosis of spermatic cord tumor. The pathological examination revealed leiomyosarcoma. The former had adjuvant radiation therapy locally. These are the 28th and 29th cases of spermatic cord leiomyosarcoma in Japan.

Functional giant parathyroid cyst with high concentration of CA19-9 in cystic fluid.

A 63-year-old man was admitted to our hospital for the evaluation of hypercalcemia and anterior neck mass. Laboratory findings revealed hypercalcemia, hypophosphatemia, and hypercalciuria, as well as elevated serum levels of parathyroid hormone (PTH) and alkaline phosphatase. Computerized tomography and magnetic resonance images showed that the mass contained a cystic area. Parathyroid scintigraphy using either 99mTc-sestamibi alone or 201Tl-chloride in conjunction with 99mTc-pertechnetate for thyroid image subtraction showed uptake of the radioactivity into the cyst wall, suggesting that the mass originated from the parathyroid. Fine needle aspiration biopsy revealed that the cyst fluid was serous and bloody with extremely high concentrations of both PTH and CA19-9. The patient was diagnosed as primary hyperparathyroidism caused by parathyroid cyst and cervical exploration was performed. The cyst was dissected away along with the right lobe of the thyroid gland. After tumor removal, serum calcium and PTH levels were normalized. Histological study showed that the tumor possessed malignant potential with capsular invasion as well as moderate cellular atypia with trabecular pattern in arrangement. Parathyroid cells in the wall of the cystic tumor were immunostained positively for CA19-9, suggesting that CA19-9 in the cyst fluid was produced from the cells.