Eosinophilic cystitis mimicking hemorrhagic cystitis in relapsed follicular lymphoma.

Eosinophilic cystitis (EC) is a rare and non-infectious inflammatory disorder characterized by transmural infiltration of eosinophils in the bladder wall. The diagnosis of EC is made only by the pathophysiological findings. Because the urinary symptoms of EC are quite similar to other urinary tract disorders including hemorrhagic cystitis (HC), it can be misdiagnosed or left undiagnosed. A 49-year-old woman with relapsed and refractory follicular lymphoma presented with sudden-onset gross hematuria after the chemo-immunotherapy. The patient was initially treated as HC with continuous bladder irrigation, resulting in recurrent and refractory hematuria. Corticosteroid dramatically resolved hematuria after the bladder biopsy revealed EC. It is important to suspect EC and perform bladder biopsy in patients with recurrent episodes of hematuria or refractory to conservative treatment for HC.

Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report.

BACKGROUND: Most groin masses are first suspected to be groin hernias. More than 80% of bulging groin lesions are reportedly diagnosed as hernias by ultrasonography. Establishment of the correct diagnosis of hernia among all differential diagnoses is not easy. We herein describe a very rare case of groin eosinophilic funiculitis that presented as an irreducible groin hernia. CASE PRESENTATION: A 59-year-old man presented to our hospital with suspicion of a right groin hernia. He had a 1-week history of a painful right groin tumor. The tumor was about 4 cm without skin redness or warmth, irreducible even in the supine position, and associated with mild tenderness. Enhanced computed tomography showed that the mass seemed to be connected to the intra-abdominal structures. With time, the patient's pain did not increase, the inflammatory response did not worsen, and no ischemic signs were observed by enhanced computed tomography. Therefore, we diagnosed the tumor as an irreducible but not incarcerated hernia and performed elective surgery. Intraoperative examination revealed no hernia sac, and a 4-×3-cm tumor was observed around the spermatic cord. A malignant tumor was not completely ruled out. High orchiectomy was performed after consultation with the urologists. Pathological examination of the tumor showed no malignant features, and the final diagnosis was eosinophilic funiculitis with massive inflammatory changes and eosinophil invasion. CONCLUSION: Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions.

Probe Heating Method for the Analysis of Solid Samples Using a Portable Mass Spectrometer.

We previously reported on the development of a portable mass spectrometer for the onsite screening of illicit drugs, but our previous sampling system could only be used for liquid samples. In this study, we report on an attempt to develop a probe heating method that also permits solid samples to be analyzed using a portable mass spectrometer. An aluminum rod is used as the sampling probe. The powdered sample is affixed to the sampling probe or a droplet of sample solution is placed on the tip of the probe and dried. The probe is then placed on a heater to vaporize the sample. The vapor is then introduced into the portable mass spectrometer and analyzed. With the heater temperature set to 130°C, the developed system detected 1 ng of methamphetamine, 1 ng of amphetamine, 3 ng of 3,4-methylenedioxymethamphetamine, 1 ng of 3,4-methylenedioxyamphetamine, and 0.3 ng of cocaine. Even from mixtures consisting of clove powder and methamphetamine powder, methamphetamine ions were detected by tandem mass spectrometry. The developed probe heating method provides a simple method for the analysis of solid samples. A portable mass spectrometer incorporating this method would thus be useful for the onsite screening of illicit drugs.

Development of a portable mass spectrometer characterized by discontinuous sample gas introduction, a low-pressure dielectric barrier discharge ionization source, and a vacuumed headspace technique.

The present study has attempted to downscale a mass spectrometer in order to make it portable and enable onsite analysis with it. The development of a small mass spectrometer required the use of a compact pump whose displacement was small, decreasing the sensitivity of that spectrometer. To get high sensitivity with a small mass spectrometer, we have integrated novel techniques: a highly sensitive ionization source and efficient extraction of sample vapor. The low-pressure dielectric barrier discharge ionization (LP-DBDI) source made it possible to increase the conductance between the source and the mass analyzer, compared with ambient ionization sources, enhancing the efficiency of the ion transfer from the ionization source to the mass analyzer. We have also developed a vacuumed headspace method efficiently transporting the sample vapor to the ionization source. The sensitivity was further enhanced by also using a discontinuous sample gas introduction technique. A prototype portable mass spectrometer using those novel techniques was found to be sensitive enough to detect 0.1 ppm methamphetamine, 1 ppm amphetamine, 1 ppm 3,4-methylenedioxymethamphetamine, and 10 ppm cocaine in liquid.

Sensitive low-pressure dielectric barrier discharge ion source.

RATIONALE: We developed a novel highly sensitive soft ionization method: a low-pressure dielectric barrier discharge ionization (LP-DBDI) source. In this configuration, samples pass through the inside of a dielectric barrier discharge (DBD). Since samples pass through a DBD and its plasma jet, high ionization efficiency is expected. Furthermore, high transmission efficiency from the ion source to the mass spectrometer is also expected since the ion source is placed in a vacuum. METHODS: Mass spectrometric detection was carried out in positive ion mode using an ion trap mass spectrometer. The LP-DBDI source or a conventional atmospheric pressure chemical ionization (APCI) source was attached to the mass spectrometer. Samples were vaporized and sent to ion sources with air flowing at a constant flow rate of 1.5 L/min. The LP-DBDI source was compared with a conventional APCI source. RESULTS: Mass spectra of methyl salicylate, 2-undecanone and methamphetamine were acquired using the LP-DBDI source. Protonated molecules were mainly observed in the mass spectra. The sensitivities for methyl salicylate and 2-undecanone obtained using the LP-DBDI source were 44 times and 39 times higher, respectively, than those obtained using an APCI source. CONCLUSIONS: LP-DBDI is a soft ionization method characterized by only minor fragmentation, similar to APCI. The sensitivity of the LP-DBDI source was found to be about 40 times higher than that of the conventional APCI source.

The effects of neoadjuvant chemotherapy and chemo-radiation therapy on MRI staging in invasive bladder cancer: comparative study based on the pathological examination of whole layer bladder wall.

OBJECTIVE: We evaluated the correlation of radiological findings obtained by MRI study with pathological diagnosis in invasive bladder cancer treated with neoadjuvant chemotherapy, with or without radiation. DESIGN, SETTING, AND PARTICIPANTS: Twenty-seven patients, who underwent total or partial cystectomy for invasive bladder tumors, were enrolled into the present study. Eight cases had received neoadjuvant chemotherapy following the staging biopsy (group A), ten cases had received chemo-radiation therapy following the staging biopsy (group B), and nine cases had received preoperative staging biopsy alone (group C). As a final treatment, 12 of the 27 patients underwent total cystectomy and the other 15 patients underwent partial cystectomy. MRI was conducted prior to total or partial cystectomy in each case. The pathological stage was assessed by histological examination of the entire layer of the bladder wall. RESULTS AND LIMITATIONS: Tumor stage assessed by MRI was consistent with pathological findings in 16 of the 27 cases (59.3%), while MRI produced over-staging in 7 cases and under-staging in 4 cases. The accuracy of staging was 75.0, 30.0, and 77.8% in groups A, B, and C, respectively. The accuracy of MRI staging in group B was lower than that in group C (P < 0.05). There was no difference in the accuracy of MRI staging between groups A and C. CONCLUSION: MRI is useful for the staging of bladder cancer. However, care needs to be taken when staging invasive bladder tumors treated with neoadjuvant chemo-radiation therapy, because inflammatory infiltrations and/or fibrous changes caused by the chemotherapy or chemo-radiation therapy make precise staging with MRI difficult.

[Metachronous testicular seminoma with an interval of 14 years from the first nonseminomatous testicular tumor: a case report].

A 32-year-old man was admitted to our hospital with a complaint of right scrotal swelling. He had a past history of left testicular nonseminomatous germ cell tumor (NSGCT), stage IIB 14 years ago. He had undergone chemotherapy with 3 courses of PEP and retroperitoneal lymphnode dissection revealing pathological CR. He was diagnosed as having right testicular tumor. He underwent right high orchiectomy. Imaging studies and pathological studies revealed pure seminoma with spermatic cord invasion, stage I, pT3N0M0. He underwent chemotherapy with 3 courses of VIP. Herein we present a case of metachronous bilateral testicular germ cell tumor with a review of literatures.

Management of extrinsic malignant ureteral obstruction with urinary diversion.

OBJECTIVE: The effectiveness of urinary diversion for patients with renal insufficiency due to extrinsic ureteral obstruction was assessed. METHODS: Between 1990 and 2003, 30 males and 45 females, ranging 36-90 years of age (average, 62.7) who had secondary ureteral obstruction due to either a retroperitoneal or pelvic invasion of malignant disease, underwent nephrostomy or ureteral stenting using a double-J stent without side holes. RESULTS: Ureteral stenting was attempted as an initial procedure in 51 of the 75 cases. The remaining 24 cases had a nephrostomy at the first step. Of 51, 37 cases were successfully stented, while internal stenting was unsuccessful in the remaining 14 cases. These 14 cases were treated with nephrostomy at the second step following the unsuccessful internal stenting. Eight cases of the 37 successfully stented cases were eventually changed to a nephrostomy because of catheter trouble. As a result, 29 cases could be managed by internal ureteral stenting up until the end of their life. The follow-up period for the 75 cases who underwent urinary diversion ranged from 5 days to 19 months, averaging 5.7 months. The average period from diversion to death was 5.6 months in the internally stented group and 5.9 months in the nephrostomy group. CONCLUSION: The high patency rate of the internal ureteral stent in our cases might be due to our use of a stent without shaft vent holes.

Oncologic assessment of hand-assisted retroperitoneoscopic nephroureterectomy for urothelial tumors of the upper tract: comparison with conventional open nephroureterectomy.

PURPOSE: To evaluate the oncologic results of our operative technique, hand-assisted retroperitoneoscopic nephroureterectomy (HRNU), for the treatment of upper-tract urothelial cancer, various perioperative parameters and oncologic outcomes were compared for HRNU and conventional open nephroureterectomy (CONU). PATIENTS AND METHODS: Thirty-six patients with clinical stage T(1,2)N(0)M(0) renal-pelvic and ureteral tumors underwent HRNU. A retroperitoneoscopic nephrectomy was carried out with hand assistance via a lower-abdominal midline incision. The lower ureter was resected by open surgery through the same incision, and the operative specimen was extracted via the same incision. Thirty-seven cases of CONU were reviewed as historical controls. Various perioperative and parameters and oncologic results were compared for the two procedures. RESULTS: The HRNU was completed in all but one case, which was converted to CONU. The mean operating time (395 minutes) was longer than that for CONU (289 minutes), and the mean estimated blood loss with HRNU (497 g) was greater than that with CONU (296 g). The mean time to oral intake (1.4 days) was shorter than that after CONU (2.3 days), and the mean time to walking was shorter (2.1 days v 2.6 days). There were no statistical differences in the cause-specific survival rate, the disease-free survival rate, or the bladder recurrence-free survival rate between HRNU (median follow-up 23 months) and CONU (median follow-up 56 months). CONCLUSION: The HRNU, a combination of endoscopic and conventional open surgery, seems to be a reasonable surgical procedure, because the lower-abdominal incision can be utilized, not only as a route for hand assistance, but also as a window for open surgery when resecting the distal ureter as well as for extraction of surgical specimens. The procedure is a safe alternative to conventional open surgery for upper urinary-tract tumors from an oncologic viewpoint.