[A case of primary malignant lymphoma of the bladder].

The patient was a 34-year-old male. He visited a community hospital complaining of macroscopic hematuria and pollakiuria. Cystoscopic examination demonstrated a bladder tumor. Transurethral resection of the bladder tumor (TUR-Bt) was performed. Histological examination disclosed malignant lymphoma (non-Hodgkin's lymphoma, mixed type). The tumor was classified into the B cell type by the immunohistological staining with surface antigens. He was referred to St. Marianna University, School of Medicine for chemotherapy. Pelvic computed tomography (CT) after admission demonstrated a tumor with a wide pedicle located in the vesicle triangle extending to the posterolateral wall of the bladder. No abnormalities were found in other organs. After establishment of the diagnosis of primary bladder malignant lymphoma, 6 courses of chemotherapy (adriamycin, vincristine, cyclophosphamide, prednisolone, etoposide, methotrexate) were performed. The tumor disappeared completely on imaging studies after chemotherapy. Biopsy of the bladder disclosed no abnormal tissues. No evidence of recurrence or metastasis was found 5 years after chemotherapy.

Results of a qualitative and field study using the WHOQOL instrument for cancer patients.

The main purpose of the study was to evaluate quality of life (QOL) among cancer patients using the WHOQOL-100 instrument and to see if any significant differences were seen in cancer stages, treatment status and prognosis. This study consisted of two parts; qualitative and quantitative. For the qualitative study, two focus groups were conducted by medical professionals to establish the applicability of the WHOQOL instrument in evaluating the QOL of cancer patients, but most participants were negative about using a generic instrument such as WHOQOL. For the quantitative study, 197 cancer patients (average age 55.86) from eight medical centers using the WHOQOL instrument, in addition to each patient's information sheet filled in by their own physicians, were analyzed. The average overall QOL score was 3.39. There was high reliability (Cronbach's alpha = 0.9685) and a high correlation between the psychological and the environmental domains (r = 0.7021), the physical domain and the level of independence (r = 0.6031) and social relations and the environment (r = 0.6856) and between health conditions perceived by patients and QOL scores. In addition, differences by gender, treatments and cancer sites were also found to be significantly different at the 5% significance level. The results indicated that the WHOQOL core instrument was sensitive enough to evaluate the QOL of cancer patients.

Bilateral chromophobe cell renal carcinoma in tuberous sclerosis complex.

We report on a patient with tuberous sclerosis complex and polycystic kidney disease who developed bilateral chromophobe cell renal carcinoma. We discuss the tuberous sclerosis complex, associated bilateral renal cell carcinoma, polycystic kidney disease and chromophobe cell renal carcinoma; a recently established subtype with a rather favorable prognosis. In a patient with tuberous sclerosis complex and multiple space-occupying lesions, a diagnosis of angiomyolipoma should be considered first but bilateral and/or multifocal renal cell carcinoma is a likely diagnosis.

[Ileovesical fistula caused by long-term indwelling of urethral catheter: a case report].

A case of an ileovesical fistula is reported. The patient was a 32-year-old female who suffered from spina bifida. She had had a urethral catheter indwelt at 13 years old for continuous incontinence caused by atrophic bladder. The patient noted lower abdominal discomfort and fecal urine at age 31 in January, 1989 and urination from anal appeared in March, 1990. In November, 1990, the patient was introduced to our hospital and diagnosed with ileovesical fistula. We performed partial cystectomy, ileal wedge resection and cystostomy on this patient. The pathological findings showed chronic inflammatory change. The ileovesical fistula may have been caused by a long-term indwelling of urethral catheter. We discussed the ileovesical fistula and the treatment of neurogenic bladder in a patient of spina bifida.

[Fertility in patients after surgical repair of membranous urethral strictures associated with pelvic fractures].

We evaluated fertility in fourteen patients after surgical repair of membranous urethral strictures associated with pelvic fractures. Eight patients were operated on using Badenoch's method (pull through) and six patients by end-to-end anastomosis of the urethra. All of them have maintained libido and potency after urethroplasty. No ejaculatory disturbance had ever occurred since surgery. Semen analysis was evaluated three months to four years after urethroplasty and serum hormone levels were measured in four patients. The results were as follows: 1) All except 2 patients had normal semen volume (more than 2 ml). 2) Nine patients (64%) had a sperm density of more than 40 x 10(6)/ml. Two patients had a sperm density of 20 to 40 x 10(6)/ml and three patients less than 20 x 10(6)/ml. 3) Nine patients (64%) had a sperm motility of more than 50%, three 30-50% and two less than 30%. 4) Seven patients (50%) had normal semen findings with a sperm density of more than 20 x 10(6)/ml and a sperm motility of more than 50% according to the WHO laboratory manual. 5) Pyospermia (WBC greater than or equal to 10/hpf) was observed in three patients. However, they never had subjective symptoms or objective findings of inflammation. 6) Serum LH, FSH, testosterone and PRL levels were within normal limits. 7) After urethroplasty, two patients married and their wives became pregnant. In conclusion, these results indicate that surgical repair of membranous urethral strictures associated with pelvic fractures has little effect on fertility.

[Acute renal failure after renal trauma in a case of a functional solitary kidney].

Herein we report a case of acute renal failure after renal trauma in a patient with contralateral hypoplastic kidney. The patient was treated conservatively including temporary hemodialysis successfully. In the case of renal trauma, the status and function of the contralateral kidney must be evaluated first, and in the case of a solitary kidney, treatment should be centered on the preservation of its function.

[Percutaneous nephrolithotomy by electrohydraulic shock wave].

Twelve patients underwent percutaneous nephrolithotomy in our hospital. Six of these patients had stone disintegration by electrohydraulic shock wave. The procedure was safe and effective for achieving rapid stone disintegration. Translocation of the stone fragments and central metal core of the probe left in the ureter were clinical problems. However, they passed spontaneously. Usefulness and problems of electrohydraulic lithotripsy were discussed.