[Clinical effects of increase in the loading dose of tamsulosin (from 0.2 mg to 0.3 mg) on urinary disturbance associated with benign prostate hyperplasia].

We determined the clinical efficacy of a loading dose of tamsulosin (0.2-0.3 mg) in patients with benign prostate hyperplasia (BPH). Tamsulosin was administered at a dose of 0.3 mg to 26 patients with BPH and moderate or severe urinary disturbance, as determined on the basis of the international prostate symptom score (I-PSS) and quality of life (QOL) severity. The I-PSS and QOL index were calculated before and at the end of the 12-week administration period. The total I-PSS and QOL index were significantly decreased at 12 weeks compared with the baseline (p=0.003, and p=0.011, respectively). Significant differences were observed in the changes in 3 I-PSS items (stream, p=0.042 ; nocturia, p=0.012 ; urgency, p=0.003). On the basis of these findings, we conclude that the administration of 0.3 mg tamsulosin to patients with BPH improves the scores of objective indexes, and may specifically ameliorate urinary storage symptoms.

[A case of metastatic lung cancer with cavitation due to urothelial carcinoma].

We report a rare case of lung cancer with cavitation that was caused by metastasis of urothelial carcinoma. A 73-year-old woman was admitted to our hospital with macrohematuria and general fatigue in September 2003. Computed tomography revealed a left ureter tumor, which was removed by left nephroureterectomy in October 2003. However, a part of the ureter could not be resected because of the adhesion that had occurred after a previous operation. The patient was diagnosed with sigmoid colon cancer, and she underwent sigmoidectomy and resection of the remaining part of the ureter in August 2004. Subsequently, transurethral resection was performed several times for bladder tumor. The pathological diagnosis in February 2005 was pT2. Cisplatin-based intra-arterial chemotherapy was performed because it was not possible to perform a cystectomy due to the poor performance status. In March 2006, computed tomography of the chest revealed a mass shadow with a cavity in the left lower lung field. This was diagnosed as primary or metastatic lung cancer and was treated by left lower lobectomy in November 2006. On the basis of the pathological findings, we diagnosed the mass as metastatic tumor secondary to the urothelial carcinoma. Despite general chemotherapy, the patient's condition deteriorated, and the patient died 1 year later.

[Successful cumulative treatment with pre/post-operative interferon-alpha, nephrectomy, and surgical resection of metastasis in advanced renal cell carcinoma : a case report].

A 55-year-old man was admitted with cough and sputum. Computed tomography revealed a left renal tumor, 7 cm in diameter, and multiple lung tumors with left pleural effusion. We considered nephrectomy impossible given his poor performance status. He received 500 x 104 IU/day of interferon alpha subcutaneously three times a week. Five months after the start of interferon alpha therapy, the renal and lung tumors were markedly reduced in size. Because of improvement of his condition and downsizing of tumors, radical nephrectomy was performed. In addition, interferon alpha therapy was continued for seven more months. At that point, all metastatic pulmonary lesions but one had disappeared. Interferon alpha therapy was then continued for one more year. About five years after the first admission, he is alive without evidence of disease.

[Secondary endocrine therapy with oral estrogen for relapsed prostate cancer].

We report clinical outcomes of secondary endocrine therapy with oral estrogen for relapsed prostate cancer. A total of 18 patients were treated with oral estrogen as a secondary endocrine therapy for relapsed prostate cancer between February 2002 and December 2007. One mg/day of ethinylestradiol was administered orally and the dose was increased to 3 mg/day if necessary. A decrease of serum prostate specific antigen (PSA) level was seen in all of the 15 patients who were able to take ethinylestradiol without severe side effects. The PSA level was decreased more than 50% in 11 out of 15 (73.3%) patients. Median re-relapse-free survival was 15 (3-32) months. This effectiveness was as good as intravenous high-dose diethylstilbestrol diphosphate (DES-DP) treatment which was used as a secondary endocrine therapy for relapsed prostate cancer at our institute previously. Oral administration of ethinylestradiol is effective and outpatients can be treated at a low cost, so it should be considered as one of the treatment options for relapsed prostate cancer after initial endocrine therapy.

Mucinous adenocarcinoma of the renal pelvis associated with transitional cell carcinoma in the renal pelvis and the bladder.

We report a case of mucinous adenocarcinoma of the renal pelvis associated with bladder carcinoma in situ (CIS). Transitional cell carcinoma (TCC) of the renal pelvis and CIS were also observed adjacent to the adenocarcinoma. Immunohistochemical assessment of the pelvic adenocarcinoma revealed positive expressions for mucin, epithelial membrane antigen, cytokeratin 7, cytokeratin 19 and carcinoembryonal antigen, but not vimentin or chromogranin. Based on the histopathological examinations, the adenocarcinoma of the renal pelvis in the present case may have a similar biological nature to conventional TCC and probably originated by development of pre-existing TCC of the renal pelvis.

Combined adrenal adenoma and myelolipoma in a patient with Cushing's syndrome: case report and review of the literature.

Myelolipoma is an uncommon benign tumor of unknown etiology and adrenal myelolipoma is rarely associated with endocrine disorders. We report a 67-year-old woman with Cushing's syndrome due to left adrenal adenoma associated with myelolipoma. The patient underwent laparoscopic left adrenalectomy and pathological examination revealed an adrenocortical adenoma associated with myelolipoma. To the best of our knowledge, 25 cases of endocrine dysfunction associated with myelolipoma have been reported in the English and Japanese literature. We review and discuss the pathogenesis of adrenal myelolipoma.