[A case of fibrous pseudotumor in the scrotum].

A 65-year-old man presented with a complaint of the swelling of his right scrotum. Ultrasonogram indicated a tumor in the right scrotum, but it was not apparent whether the tumor arose from the right testis or not. Right high orchiectomy was performed due to the suspicion of malignancy. The tumor arose from the right epididymis and spermatic cord. Histological examination revealed that the tumor was a fibrous pseudotumor in the scrotum.

[Chemotherapy in hemodialysis patient with metastatic testicular cancer; pharmacokinetics of etoposide and cisplatin].

The pharmacokinetics of intravenously administrated cisplatin and etoposide were studied in a patient with seminoma (stage IIIA) receiving hemodialysis for chronic renal failure. The treatment schedule was as follows: 7 mg/m2 of cisplatin at day 1, 3, 5; 14 mg/m2 of cisplatin at day 2, 4; 70 mg/m2 of etoposide at day 1-5; hemodialysis at day 2, 4. After the treatment myelosuppression was very strong. So the patient were received another treatment of smaller doses of cisplatin and etoposide in three courses. The other schedule was as follows: 14 mg/m2 of cisplatin at day 1, 3, 5; 35 mg/m2 of etoposide at day 1-5; hemodialysis at day 1, 3, 5. The area under the blood concentration-time curve (AUC) of free-cisplatin was 6.82 micrograms.hr/ml in first course, 4.07 micrograms.hr/ml in second course. The peak concentration of peripheral blood free-cisplatin was 0.58 microgram/ml in first course, 0.43 microgram/ml in second course. The AUC of etoposide was 241.9 micrograms.hr/ml in first course, 216.9 micrograms.hr/ml in second course. After treatment CR was observed and there was no recurrence for five years. In conclusion, it was considered that cisplatin and etoposide could be given to the patient receiving hemodialysis for chronic renal failure and smaller doses should be given to prevent side effects.

[Clinical results of extracorporeal shock wave lithotripsy for upper urinary tract stone using Siemens Lithostar2].

Between May 1994 and March 1996, a total of 427 cases of upper urinary tract stones were treated by extracorporeal shock wave lithotripsy (ESWL) using a Siemens Lithostar2. Of 427 patients, 167 had renal stones and 260 had ureteral calculi. A double J stent was inserted preoperatively for patients with stones > or = 20 mm in diameter. The success rate after 3 months, defined as complete disappearance of stone or partial disintegration with residual stones < or = 4 mm in diameter, was 82.4% and 88.1% for the renal and ureteral calculi, respectively. Additional treatments were required in 9 cases (transurethral ureterolithotripsy in 5, percutaneous nephrostomy in 2, nephrolithotripsy and ureterolithotomy in 1 each). There were no serious side effects requiring surgical treatment or blood transfusion, although perirenal hematoma developed in 5 patients, who were treated conservatively. It is concluded that ESWL using Simens Lithostar 2 is safe and useful for treating upper urinary tract stones.

[A case of bilateral upper urinary tract tumors after radical cystectomy].

We report a case of bilateral upper urinary tract tumors after total cystectomy. A 67-year-old male with multiple bladder tumors underwent total cystectomy and ileal conduit urinary diversion. Pathological diagnosis was transitional cell carcinoma, grade 3 (G3), pT1b. Followup urinary cytology continued to be negative. Percutaneous antegrade pyelography revealed multiple bilateral upper urinary tract tumors 21 months post-operatively. Bilateral nephroureterectomy and resection of ileal conduit were performed. Pathological examination revealed transitional cell carcinoma, G3 in bilateral pelvis and ureter. Routine careful examination is necessary after total cystectomy.

Changes in lymphocyte subsets following administration of interleukin 2 and cyclophosphamide in mice with transitional cell carcinoma.

We investigated the effects of combination therapy with interleukin 2(IL-2) and cyclophosphamide (CPM) in C3H/HeN mice implanted with mouse bladder tumor cells (MBT2). Tumor growth was suppressed in the mice treated with IL-2 alone and mice treated with CPM alone, although not completely. However, tumor growth was completely suppressed in the mice treated with both IL-2 and CPM. As for lymphocyte subset analysis of the spleen using flow cytometry, the frequency of Lyt2+ cells and asialo GM1+ cells was significantly higher in the mice treated with IL-2 and CPM compared to the other groups. In the lymphocyte subset analysis of the thymus, the frequency of L3T4-Lyt2+ cells was significantly lower in the mice treated with CPM alone and mice treated with IL-2 and CPM compared to the other groups.

A study of antitumor effects of thymosin on rat and mouse urinary bladder carcinoma induced by N-butyl-N-(4-hydroxybutyl)-nitrosamine.

N-Butyl-N-(4-hydroxybutyl)-nitrosamine (BBN), which induces bladder carcinoma in female Wistar rats and female C3H/HeJ mice, was given as 0.025% (w/v) solution to rats and 0.05% to mice in the drinking water. Thymosin fraction 5 (TF5) or thymosin alpha 1 (T alpha 1) dissolved in normal saline, and normal saline (control) respectively were injected into the right thigh IM twice a week in the experimental rats. At the 30th week of BBN oral administration, weights of urinary bladder were different among the three groups. Bladder weights and incidence of bladder carcinoma were significantly lower in the TF5-treated group as compared with control group. Natural killer cell activity of splenic lymphoid cells was significantly elevated in the TF5-treated group as compared with the control group. However, these parameters were not significantly different between the T alpha 1-treated group and control saline-treated group. On the other hand, bladder weights and incidence of bladder carcinoma were not significantly different among TF5-, T alpha 1- and saline-treated groups at 10, 15, 20, and 25 weeks of BBN administration in mice according to the same protocol as rats.

Suppressive effects of urine on the SOS responses induced by UV and chemical mutagens.

We studied the antimutagenic effects of urine on the SOS-inducing activity of mutagenic substances by using a novel test system (umu-test) for detecting DNA damaging agents, which uses a new tester strain (Salmonella typhimurium TA1535/pSK1002). The SOS-inducing activity of chemicals was detected in terms of the level of umu operon expression by measuring beta-galactosidase activity. We first examined the effects of various amounts of urine on SOS responses caused by mitomycin C (MMC). As a result, the urine suppressed beta-galactosidase activity of MMC dose-dependently. A urine concentration of 50 microliters/ml in the medium also suppressed 89.9% of SOS response induced by 0.1 microgram/ml of PEP, 75.6% of that induced by 0.02 microgram/ml of AF2 and 60.9% of that induced by 0.1 microgram/ml of AFB1. In addition, a urine concentration of 50 microliters/ml in the medium also suppressed 85.6% of SOS response by 5 J/m2 of UV irradiation. The observed suppression seemed to be directly related to the SOS responses at a cellular level, rather than to interaction between urine and mutagens, because the urine suppressed SOS responses induced not only by various mutagens but also by UV irradiation. These results suggest that urine works as a strong antimutagen against UV and chemical substances.

[Morphological changes of Kock pouch investigated by autopsy two years nine months postoperatively].

A 62-year-old male patient consulted us because of gross hematuria and was diagnosed as having a bladder tumor. Total cystectomy was performed and a Koch pouch was utilized. Two years and nine months later, he died as a result of recurrence of bladder tumor and pathological autopsy was performed. A microscopic section of the reservoir mucosa showed a reduction in the number of crypts and an increase in the number of goblet cells. These morphological changes seemed to be caused by chronic exposure to urine, but have a favorable effect upon metabolic alterations following the utilization of the Kock pouch.

[Antitumor defense mechanisms in mice with progressively growing murine bladder tumor (MBT-2)].

MBT-2 in C3H/HeN mice was used as a model to examine cytotoxic activity. The cytotoxic activities examined were those of natural killer cells (NK), lymphokine activated killer cells (LAK), and tumorcidal macrophage (M psi). NK activity increased in early tumor bearers, but LAK and M psi activities increased in middle tumor bearers. NK activity was inhibited in late tumor bearers, but LAK and M psi activities were not inhibited. Cell surface markers and production of various cytokines were examined in order to analyze the changes in each activity.

[Peripelvic extravasation after extracorporeal shock wave lithotripsy: a case report].

We experienced a case of peripelvic extravasation after extracorporeal shock wave lithotripsy (ESWL) treatment. A 62-year-old man was admitted to our hospital with a complaint of macroscopic hematuria. The patient was diagnosed as having a radiolucent stone in the right kidney and ESWL treatment was performed to focus the stone by using drip infusion pyelography (DIP) under epidural anesthesia. The patient had right flank pain two weeks after ESWL treatment. DIP and computerized tomography (CT) showed peripelvic extravasation of contrast medium. Right pain improved after a double-J catheter was placed for decreasing intra-pelvic pressure. As a result, the disappearance of peripelvic extravasation was recognized by DIP and CT. We reviewed four cases of peripelvic extravasation after ESWL treatment including our case in the Japanese literatures and discussed the cause of peripelvic extravasation after ESWL treatment.

Combined effect of interleukin 2 and cyclophosphamide in therapy of mice with transitional cell carcinoma.

We investigated the effect of combination therapy with interleukin 2 (IL-2) and cyclophosphamide (CPM) in C3H/HeN mice implanted with mouse bladder tumor cells (MBT2). MBT2-bearing mice were treated with a single intraperitoneal injection of 120 mg/kg CPM on day 10 and/or subcutaneous administration of 5 x 10(4) units IL-2/day from day 11 to day 20. As a result, the growth of tumor in mice treated with IL-2 alone was slightly suppressed. On the other hand, regression was observed in all mice treated with CPM alone, although regrowth of tumor was seen in all of them. However, when IL-2 was administered with CPM, regrowth of tumor was completely suppressed. An immunologic study was done that showed cytotoxicity against YAC-1 and P815 in the spleen cells was suppressed in mice treated with CPM alone, but that both recovered to control levels when IL-2 was administered with CPM. Cytotoxicity against MBT2 in the spleen cells was most elevated in mice treated with both IL-2 and CPM. These findings suggested that clinical evaluation of combination therapy with IL-2 and CPM may be worthwhile.

[Combined effect of TNF and anticancer chemotherapeutic agents on murine bladder tumor (MBT-2)].

The antitumor activity of combination therapy of recombinant human tumor necrosis factor alpha (rHu-TNF alpha) and chemotherapeutic agents against murine bladder tumor (MBT-2) was studied. Tumors were intradermally transplanted into the hind leg of C3H-HeN mice and allowed to grow until they reached a diameter of 8 to 10 mm 10 days after transplantation. TNF (3,000 units) was given intraperitoneally from day 10 to day 19, and the chemotherapeutic agents, 5-FU (60 mg/kg), CPM (100 mg/kg), CDDP (10 mg/kg) and ADM (5 mg/kg), were applied once intraperitoneally on day 10. The antitumor effects were evaluated based on tumor volume on day 20. 5-FU, CPM and ADM enhanced the antitumor effect when combined with TNF, but CDDP did not. These findings suggest that combination therapy of TNF and certain antitumor chemotherapeutic agents is effective cancer treatment.

[A case of renal cyst associated with renal cell carcinoma--characteristics of intracystic fluid associated with renal cell carcinoma from Japanese reports].

The patient was a 56-year-old male. Renal cyst and intracystic mass were incidentally found in the right kidney by ultrasound sonography. Intracystic mass was enhanced. At operation, intracystic fluid was clear and yellow, and its cytology was negative. However, rapid histological examination of the intracystic mass showed malignancy. Accordingly, nephrectomy was performed. We then reviewed the characteristics of the intracystic fluid in renal cell carcinoma reported in Japan and found that 70% was bloody intracystic fluid and 30% showed positive cytology. These findings suggested that we should to be more careful when diagnosing renal cyst associated with renal cell carcinoma only by the examination of the intracystic fluid.

Thymus lymphocytes in uraemic rats and the effect of thymosin fraction 5 in vivo.

Thymus lymphocyte subsets in uraemic rats were studied using monoclonal antibodies. Severe and moderate uraemia was induced in rats, and sham-operated and normal rats were used as the controls. As a result, the weight of the thymus decreased in uraemic rats. As for lymphocyte subsets, the frequency of W3/25+OX8+ decreased and those of W3/25-OX8-, W3/25+OX8- and W3/25- OX8+ relatively increased in uraemic rats. All these changes were more significant in severely uraemic than in moderately uraemic rats. When thymosin fraction 5 (TF5) was administered to severely uraemic rats, the weight of the thymus increased and the lymphocytes subsets normalized. These results suggest that uraemia may cause a maturational impairment of thymus lymphocytes by the depression of thymic hormone secretion.

Clinical studies on cell-mediated immunity in patients with renal cell carcinoma: interleukin-2 and interferon-gamma production of lymphocytes.

The authors examined interleukin-2 (IL-2) production and interferon gamma (IFN gamma) production of peripheral blood mononuclear cells in 28 patients with renal cell carcinoma and 17 control subjects. The peripheral blood was obtained prior to the initiation of therapeutic procedures. The patients were divided into two groups according to tumor size, less than or equal to 5 cm and greater than 5 cm. The production of IL-2 and IFN gamma was measured by immunoradiometric assay. As a result, in the patients with tumors greater than 5 cm, IL-2 and IFN gamma production was impaired. However, in the patients with tumors less than or equal to 5 cm, IFN gamma production was enhanced, though IL-2 production was not significantly different from that of the control subjects. There was no significant correlation between IL-2 production and IFN gamma production.

[Experience of extracorporeal shock-wave lithotripsy for the urolithiasis in horseshoe kidney].

At Osaka City University, 1,987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

[Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone].

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1,701 patients in a total of 2,438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1,200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

[Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones].

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined therapy of interleukin 2 with cyclophosphamide or bacillus Calmette-Guérin against implanted bladder cancer cells in mice.

1 x 10(5) cells of FAMFT-induced bladder cancer cell line (MBT-2) were injected into the right leg of the C3H/He mice. 10 days later, these animals with the same tumor size were divided into four groups. Group 1 is the control with no treatment. Group 2 underwent interleukin 2 (IL-2) treatment for 10 days since the 11th day after tumor inoculation. Group 3 received just one CPM injection on the 10th day. Group 4 had a combination therapy of CPM, followed by IL-2. Group 1 and 2 exhibited enlargement of tumor size, resulting in the death of all animals. Administration of CPM led to temporary disappearance of tumor, followed by local tumor recurrence in all cases. However, combined therapy with IL-2 showed complete remission of the tumors. Natural killer cell activity measured by the 51Cr release assay of the spleen cells using Yac-1 cells as target cells 20 days after tumor inoculation was found to be significantly higher in group 2 and 4, while lymphokine-activated killer cell activity of the spleen cells against P-815 cells showed no significant difference between the four groups.

Examination of aggravating factors of urinary excretion of N-acetyl-beta-D-glucosaminidase after extracorporeal shock wave lithotripsy.

We measured urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion before and after extracorporeal shock wave lithotripsy (ESWL) with a view to study the underlying factors which aggravate renal impairment immediately after ESWL. The factors associated with the significant elevation of urinary NAG after ESWL included female sex, a previous history of ESWL, and urinary tract infection (UTI). By studying the backgrounds of these factors, we found that both the female group and the group with a previous history of ESWL contained significantly more patients with UTI. These findings indicate that UTI may be one of the risk factors which aggravate renal damage immediately after ESWL, and that careful management is necessary in the ESWL treatment of urinary tract stones with UTI.