Biomedical subjects
Publications and source records attributed to K Tobisu.
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A 52-year-old male was admitted to this hospital as stage D2 prostatic carcinoma. He had been previously treated with transurethral resection of prostate and hormonal therapy. Rectal examination revealed the prostate bigger than a hen-egg with stony-hard nodules. Both whole body bone X-ray and bone scintigram showed multiple bone metastasis. Total cysto-prostatectomy and pelvic lymph node dissection were performed because the patient was relatively young, was in good general status and the tumor was not sensitive to hormonal therapy. In addition, he was expected to have obstructive uropathy soon and the reported results of radiotherapy for local control of advanced prostate cancer were unsatisfactory. He was followed by bone X-ray and bone scintigram every six months. Osteoplastic area diminished in size and hot lesions in bone scintigram disappeared gradually. The patient is very active in his daily life without evidence of local recurrence or new metastasis more than seven years after operation. The validity of mass reduction surgery for hormone-resistant stage D2 prostatic carcinoma is discussed.
Of 203 patients with transitional cell carcinoma of the urinary bladder which had been cystectomized and examined by step-sectioning during the period between 1969 and 1986, 33 had coexistent papillary, papillonodular and/or nodular carcinomas in the bladder. Of them, 12 (36%) had a history of papillary carcinomas, 26 (79%) had multiple tumors and 22 (67%) had a concomitant carcinoma in situ, and/or mucosal dysplasia. Moreover, microscopic papillary structures were identified in 32 out of the 33 (97%) cases with papillonodular and/or nodular carcinomas, indicating some of the nodular invasive carcinomas in the bladder to have developed from papillary carcinomas.
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Two cases of bladder carcinoma are described. The patients were of similar age, were both smokers and were treated for the same period, but exhibited completely different later clinical courses. Initially, both had a single, papillary, pedunculate tumor, identified as a transitional cell carcinoma, grade 2, pTa. One patient, six years later, had multiple papillary tumors covering almost all the mucosal surface and underwent simple cystectomy. Histologically the tumors were identified as transitional cell carcinomas, grade 2, pT1. The other patient, nine years later, had a single nodular invasive tumor with a concomitant, very tiny papillary tumor and underwent radical cystectomy. Histologically the tumor was transitional cell carcinoma, grade 2 greater than 3, pT4. Many of the questions raised by these cases are unanswered, but comparison of such cases should provide some clues to the natural history of bladder carcinoma.
A primary neoplasm arising in a vesical diverticulum was cystectomized and analyzed by step-sectioning of the whole bladder in an attempt to determine the carcinogenic process. Serial sections of the cystectomy specimen revealed a small area of mild dysplasia in the mucosa of the bladder and the diverticulum without a tumor. Most of the mucosal cells in the tumor-bearing diverticulum were desquamated, but a small area of dysplasia in the remaining cells was also observed.
Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.
Herein we report a 36-year-old man with hyperparathyroidism and a past history of internal irradiation to the thyroid. Twelve years previously at age 24 years he had received 8 mCi of radioactive iodine for Graves' disease. An additional dose of 4 mCi was required 3 years later. A right lower parathyroid adenoma (28 X 23 X 20 mm, 5.7 g) was found at neck exploration. Although the association of external ionizing radiation to the head and neck and the subsequent development of hyperfunctioning parathyroid glands has been described in recent years, there are only 4 cases in the literature of parathyroid surgery for hyperparathyroidism secondary to earlier treatment with radioactive iodine for Graves' disease. In a long-term follow-up of 180 patients treated with radioactive iodine for Graves' disease, neither hypercalcemia nor hypophosphatemia was found. Whether internal radiation therapy can be a causative factor in the development of hyperparathyroidism should be elucidated in future. However, it seems reasonable to suggest that patients whose hyperthyroidism has been treated with radioactive iodine should have their serum calcium levels examined at 5-year intervals.
The experience with hepatectomy for metastatic renal cell carcinoma (RCC) has been very rarely reported, because multiple organ metastases ordinarily coexist when hepatic metastases are found out. Three patients who underwent hepatectomy for metastatic RCC are presented here. Radical nephrectomy was performed for the primary renal lesions in all the patients, and their hepatic metastases were resected simultaneously in one of them with a solitary tumor, and about one month later in two of them with multiple (3 and 6) tumors. These operations produced no distinct complications. The patients with 1 and 3 hepatic metastatic lesions survived without tumor recurrence for 12 and 21 months, respectively, while the patient with 6 hepatic metastatic lesions had tumor-free interval of only 2 months and died 10 months after hepatectomy due to lung metastasis. Hepatectomy may be the only promising treatment for hepatic metastases from RCC, but the indication for surgery should be evaluated according to the number of hepatic metastases.