USEFULNESS OF FECAL INCONTINENCE CATHETER (Flexi-Seal®) FOR POSTOPERATIVE MANAGEMENT OF EVACUATION IN FOURNIER'S GANGRENE: TWO CASE REPORTS.

In patients with Fournier's gangrene, massive debridement is necessary. The debrided region is usually near the anus, which means that management of evacuation becomes difficult and a colostomy is often created for diversion of stool. Our two patients were a 72-year-old man with scrotal swelling and disturbance of consciousness and a 65-year-old man with scrotal swelling and fever. In both patients, CT scanning revealed air in the scrotal sac. We diagnosed Fournier's gangrene and operated on both patients immediately. After debridement, we used a fecal incontinence catheter, a Flexi-Seal® to keep the wound clean of stools without creating a colostomy. Both patients recovered without developing wound infection. These cases demonstrate the usefulness of the Flexi-Seal® for management of evacuation in Fournier's gangrene patients after debridement.

[Case of multiple lung metastases of renal cell carcinoma failing to respond to Interferon-alpha (IFN-alpha) and sunitinib but markedly responding to everolimus].

The case pertains to a 47-year-old male. He consulted our institute regarding a tumor in his right kidney. Endoscopic retroperitoneal nephrectomy of the right kidney was conducted to remove the tumor. The postoperative pathology was Renal Cell Carcinoma (Clear cell carcinoma, pT1b, pNx, V (+), Fuhrman grade 4). Multiple lung metastases were observed upon CT scan the following year. Sunitinib was administered following Interferon alpha (IFN-alpha) therapy; however, the lung metastases became larger, so administration of everolimus at 10 mg/day was commenced. The lung metastatic lesion became smaller upon CT scan from 6 weeks following administration, and it was determined that the therapeutic effect was PR. The PR was still maintained upon CT scan 31 weeks following administration but the lung metastatic lesion still remained; therefore, right lower lobe resection and lymph node biopsy were conducted upon obtaining informed consent. The administration of everolimus at 10 mg/day is still subsequently being continued due to viable tumor cells being observed in the lung metastatic lesion and the lymph node. At present, 43 weeks have past since the start of everolimus administration, but no new metastatic lesions have been observed.

Alpha methylacyl-CoA racemase (AMACR) in prostate adenocarcinomas from Japanese patients: is AMACR a "race"-dependent marker?

BACKGROUND: Alpha methylacyl-CoA racemase (AMACR) is a useful diagnostic marker for prostate adenocarcinoma. However, its usefulness has not been fully validated in Japanese patients. The aim of this study was to evaluate the diagnostic utility of AMACR in prostate needle biopsy examination in Japanese patients. METHODS: A total of 119 prospective consecutive prostate needle biopsy specimens (680 cores) obtained from Japanese patients were examined. Sixty patients had adenocarcinoma (adenocarcinoma, 160 cores; benign, 204 cores), 14 patients had high-grade prostatic intraepithelial neoplasia (HGPIN; 19 cores), and 45 patients did not have any neoplastic lesions (297 cores). AMACR expression was scored semi-quantitatively as 0 (no expression), 1+ (partial and/or weak expression), or 2+ (strong, circumferential expression). The number of positively stained glands was counted. RESULTS: 2+ AMACR expression was observed in 70.1% of adenocarcinoma cases and in 52.6% of HGPIN cases. Of the adenocarcinoma cases showing 2+ AMACR expression, 34.8% demonstrated a heterogeneous expression pattern, with 1-75% of AMACR-positive glands. Three hundred eighty-five of the benign glands with an adenocarcinoma component showed 2+ AMACR expression (35 cases, 94 cores). 2+ AMACR expression was observed in 67 non-neoplastic benign glands (9 cases, 19 cores). CONCLUSIONS: The sensitivity and specificity of AMACR for the diagnosis of prostate adenocarcinoma and benign glands in Japanese patients are lower than those previously reported in Western countries. Pathologists should be cautious while interpreting AMACR expression pattern in Japanese patients.

[Clinicopathological study of the 1973 who classification and the WHO/ISUP classification in pTa bladder carcinoma].

PURPOSE: To compare the usefulness of the World Health Organization (WHO) 1973 classification with the WHO/International Society of Urological Pathology (ISUP) classification in pTa bladder tumors. MATERIALS AND METHODS: A retrospective analysis was performed on 132 patients (107 men and 25 women; mean age 69 years) with a initial diagnosis of pTa bladder carcinoma. Median follow-up were 67 months. On the WHO 1973 classification, histopathological evaluation of initial diagnostic specimens revealed 51 cases with grade1, 68 cases with grade 2, 13 cases with grade3. All histological slides were examined by one genitourinary pathologist blinded with respect to clinical outcome and were classified according to the WHO/ISUP classification. Disease progression was defined as up stage (> or = pT1). Actual probability of progression-free and recurrence-free survival rate were estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, histopathological grade, and adjuvant intravesical therapy. The dependent variable was disease progression and recurrence. RESULTS: The tumors were reclassified as low grade carcinoma in 77 and high grade carcinoma in 55. During the follow-up, 68 patients experience recurrence, 14 patients experienced disease progression. On the WHO 1973 classification, the risk of recurrence was significantly lower in patients with grade 1 compared to those with grade3 (p = 0.007). On the WHO/ISUP classification, the risk of recurrence and disease progression were significantly lower in patients with low grade compared to those with high grade (p = 0.003, P = 0.01). After adjustment for tumor multiplicity and adjuvant therapy, the relative risks of recurrence and progression in the low grade carcinoma versus the high grade carcinoma was 2.0 (95% confidence intervals 1.26-3.31), 5.6 (95% confidence intervals 1.54-20.48). CONCLUSIONS: In pTa bladder carcinoma, the WHO/ISUP classification was more useful prognostic factor than the WHO 1973 classification.

[Clinical study of radical prostatectomy for prostate cancer from a single institution].

PURPOSE: To investigate the outcomes for single institution with prostate cancer treated with radical prostatectomy (RP). MATERIALS AND METHODS: A retrospective analysis was performed on 406 patients who underwent RRP from January 1991 to December 2005 for cT1-3N0M0 prostate cancer. To evaluate the change of the patient background, we divided the 15 years into the 5 periods whose span was 3 years each and examined. Biochemical recurrence was defined as a prostate-specific antigen (PSA) of > or = 0.2 ng/ml. Clinical recurrence was defined as metastases or local recurrence. Actual probability of cancer specific mortality was estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Preoperative parameters analyzed were patient age, preoperative PSA, clinical stage, Gleason score, and Neoadjuvant hormonal therapy. Multivariate analyses (logistic regression and Cox proportional hazard model) for the dependent variables (organ-confined prostate cancer, clinical recurrence free survival and cancer specific mortality) were performed. Perioperative complications between cT1/2 with cT3 were compared. RESULTS: The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Median follow-up and median patient age were 55 month and 69 year. Of the 406 men, 35 (8.6%) developed clinical recurrence, 15 men (3.7%) died from prostate cancer within the follow-up period. For pT0/2, pT3a, pT3b and pN +, the 10-yr cancer specific survival rate was 100%, 92%, 81% and 67%, respectively. Preoperative PSA (p < 0.0001), clinical stage (p = 0.004), Gleason score (p < 0.0001) and neoadjuvant hormone therapy (p = 0.0003) are predictive variables for organ confined prostate cancer. Preoperative PSA (p = 0.002) and clinical stage (p = 0.03) are prognostic variables for cancer specific mortality. There was significant difference in surgery time (p = 0.04) and blood loss (p = 0.0007) in cT1/2 cases compared with cT3 cases. CONCLUSION: The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Neoadjuvant hormone therapy prior to prostatectomy was a significant improvement in the organ confined rates. However neoadjuvant hormone therapy did not improve patient prognosis. Preoperative PSA and clinical stage are prognostic variable for cancer specific mortality.