[A Case of Testicular Tumor with Multiple Metastasis Leading to Complete Response after Treatment Interruption].

A 39-year-old man experiencing cranial nerve symptoms was referred to our neurosurgery department after a brain tumor was detected on computed tomography (CT) scans at a local hospital. Due to convulsive symptoms, the patient was admitted to our hospital for detailed examination. The patient was diagnosed with right testicular tumor, multiple brain metastases, multiple lung metastases and right kidney metastases, and was transferred to our urology department. Since the testicular tumor was staged as IIIC and identified as poor prognosis by the International Germ Cell Consensus classification (IGCCC), Bleomycin Etoposide Cisplatin (BEP) chemotherapy was initiated prior to surgery. A right high orchiectomy was performed after two courses of BEP chemotherapy. Histopathology revealed mixed germ cell tumors (seminoma and/or embryonal carcinoma+teratoma) along with the following results : ly (-) ; Intratubular Malignant Germ Cells (ITMGC) (+, viable) ; tunica albuginea invasion (-) ; spermatic cord invasion (-) ; tumor size (73× 50×45 mm). Two additional courses of BEP chemotherapy and two courses of Paclitaxel Ifomaide Cisplatin(TIP) chemotherapy were performed successively. The CT revealed metastatic lesions shrinking steadily but the metastatic foci still remained. Since tumor markers were not negative, continuous chemotherapy was considered. However, strong side effects were expected, and treatment was discontinued. Since then,the tumors continued to shrink, and the tumor markers became negative. Currently, the patient maintains complete response and is being followed-up.

[Two Cases of Urachal Carcinoma Treated by TS-1/CDDP as Adjuvant Chemotherapy].

Case 1 : A 48-year-old man presenting with gross hematuria was suspected to have a tumor located in the bladder dome. He was referred to our department for further examination and treatment. Cystoscopy showed a dome-shaped mass in the supravesical region. Computed tomography and magnetic resonance imaging indicated the possibility of urachal carcinoma and peritoneal dissemination. Therefore, partial cystectomy with urachal resection was performed. The intraoperative findings were disseminated peritoneal nodules and mucus entering the peritoneal cavity from the tumor. On pathological examination, the tumor was classified as a mucinous-type adenocarcinoma, and 6 courses of TS-1/cisplatin (CDDP) therapy were administered to the patient as adjuvant chemotherapy. To date (10 months since the surgery), there has been no disease progression. Case 2 : A 76-year-old woman was referred to our department with a finding of a tumor in the bladder dome during her detailed examination for lung tumors. Cystoscopy showed nodular tumors, indicating lung metastases of the urachal carcinoma. Therefore, partial cystectomy with urachal resection was performed. On pathological examination, the tumor was classified as an enteric-type adenocarcinoma, and 2 courses of TS-1/CDDP therapy were administered to the patient as adjuvant chemotherapy. However, due to the development of marked bone marrow depression, the drugs had to be discontinued. Nonetheless, the lung metastases markedly diminished in size. To date (9 months since the discontinuation of chemotherapy), there has been no disease progression.

Complications of urologic laparoscopic surgery: a single institute experience of 1017 procedures.

PURPOSE: We evaluated complications of urologic laparoscopic surgery at our institution. PATIENTS AND METHODS: From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively. RESULTS: Among the 1017 laparoscopic procedures, 148 complications occurred in 123 patients, resulting in a total complication rate of 14.6%. Conversion to open surgery occurred in 20 (1.9%) patients. Nephrouretectomy had the highest incidence of complications at 23.7%, which was significantly higher than that of other procedures classified as "difficult" group, according to the ESS (P < 0.05). Clavien grades I and II accounted for 73.8% of all the postoperative complications. We experienced one fatality that was caused by air embolism. CONCLUSION: We evaluated the complications of each procedure using the ESS for classification of technical difficulty. Based on the results of our retrospective study, nephrouretectomy should be upgraded as "very difficult" group according to the ESS. Appropriate grading by technical difficulty is beneficial for the prevention of complications from laparoscopic surgery.

[Schwannoma of the penis: a case report].

A 39-year-old man presented with a painless nodule on the left dorsal aspect of root of the penile shaft, which was first noticed in childhood, but had been left untreated. This nodule gradually increased in size, and he visited the Department of Urology. He had no urinary symptoms, and there was no interference with sexual intercourse. Upon physical examination, we observed a well-defined, firm 20 mm nodule on left dorsal aspect of root of the penile shaft that was tender and had no adhesion to overlying skin. There were no other abnormalities; in particular, no other similar lesions could be found. We suspected a benign tumor of the penis and removed it. Histological examination revealed a benign schwannoma composed of Antoni A and Antoni B areas.

Sexually dimorphic muscles in the forelimb of the Japanese toad, Bufo japonicus.

During the breeding season, male anurans display clasping behavior by holding females with their forelimbs. This behavior is peculiar to males, and may require specializations in forelimb musculature. The present study revealed that five kinds of forelimb muscles were heavier in the male Japanese toad than in the female: the flexor carpi radialis (FCR), the flexor antibrachii medialis caput superius (FAMsup), the abductor indicis longus (AIL), the extensor carpi radialis caput superius (ECRsup), and the flexor antibrachii lateralis superficialis caput superius (FALSsup). In addition, one breast muscle, the coracoradialis (CR), was also heavier in males than in females. A quantitative analysis of muscle fibers processed for myosin ATPase activity showed that, in such "sexually dimorphic muscles" of the female, both fast (twitch) and slow (tonic) muscle fibers were of smaller diameter than in other forelimb muscles of both sexes (all male muscles plus "nondimorphic muscles" of the female). Moreover, both types of fibers were less numerous than in the corresponding muscles of the male. These results suggest that the "sexually dimorphic muscles" are used especially for clasping by the male and are degenerative or subnormal in the female. Slow muscle fibers were neither peculiar to, nor abundant in, these clasping muscles, although they may well be necessary for tonic and prolonged contractions of the forelimb muscles during clasping. The mechanism of sexual dimorphism may be a direct action of androgens on clasping muscles or an indirect action on clasping muscles via the innervating motoneurons.