Biomedical subjects
Publications and source records attributed to M Yokokawa.
We report a case of renal papillary necrosis in a 18-year-old female. Urinary tract obstruction induced by a calculus seems to be the only etiologic factor in this case, although the multifactorial nature of this lesion has been stressed.
Secondary cutaneous T-cell lymphoma may present with various types of skin lesions, but rarely produces ulceration in contrast to primary cutaneous T-cell lymphoma. We report a case of malignant lymphoma of the tonsil that recurred as a giant cutaneous ulcer on the back of a 45-year-old man. Biopsy of the ulcer revealed a malignant lymphoma of diffuse, mixed-cell type. Surface marker analysis of the tumour cells showed suppressor/cytotoxic T-cell characteristics. The skin lesions were treated by electron beam therapy.
Bunazosin hydrochloride (Ea-0643), a selective alpha 1-blocker, was administered to 14 patients with neurogenic bladder over prolonged periods of time in order to determine its efficacy and safety. Subjective symptoms were classified into 4 grades, and their response assessed after 12 weeks of treatment. The proportion of patients showing improvement by at least one grade was 50.0% for retarded urination, 16.7% for prolonged urination, 25.0% for urinary stream condition, 25.0% for abdominal pressure at voiding, and 28.6% for residual urine. Objective symptoms were also assessed after 12 weeks of treatment, and a statistically significant improvement was recognized in the volume of spontaneously voided urine, the maximum and mean flow rates on uroflowmetry. It should be noted that both of those flow rates had improved significantly only 2 weeks into the treatment. The degree of improvement in subjective and objective symptoms and the degree of general improvement were all higher at week 12 than at week 2 of treatment. Current knowledge of the mechanism of action of this drug, coupled with the observations made in this study, suggests that, once it has improved the urodynamics, it exhibits a sustained effect for prolonged periods of treatment. However, further studies are warranted concerning the mechanisms of the pharmacological action of the drug from a pathological viewpoint. The proportion of patients in whom Ea-0643 was judged to be useful at 12 weeks of treatment was 41.7%, but when the assessment of 'slightly useful' was taken into consideration, the usefulness rate rose as high as 91.7%. Stomatitis was observed in only one case as a side effect of this drug.(ABSTRACT TRUNCATED AT 250 WORDS)
From January, 1987 through January, 1990, partial cystectomy was performed for 4 (18%) of 22 patients with invasive bladder cancer who had received neoadjuvant intra-arterial chemotherapy. The criteria of patient selection for partial cystectomy were: 1) invasive bladder cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) solitary or localized tumor that can be eradicated by segmental resection, and 3) tumor of stage T3 or less. As a rule, cisplatinum (100 mg/m2) and THP-adriamycin (40 mg/m2) were administered selectively to the internal iliac artery by one-shot infusion. Concurrently, sodium thiosulfate (10 g/m2), a neutralizing agent against cisplatinum, was administered intravenously. All four patients had achieved clinical complete responses by one or two courses of intra-arterial chemotherapy, and then underwent partial cystectomy with pelvic lymphadenectomy. Pathological examination revealed pTONO in two patients, and the remains were pT3aNO and pT3bN1. After the mean follow-up of 24 months, three of them are alive with no evidence of disease, and also with normal bladder and sexual functions. However, one with pT3bN1 tumor underwent total cystectomy 5 months later for local recurrence (pT4b) and had died of cancer 18 months later. Neoadjuvant intra-arterial chemotherapy followed by partial cystectomy should be the most applicable conservative therapy with high radicality for invasive bladder cancer, when: 1) the patient has localized invasive cancer showing good response (greater than or equal to PR) to neoadjuvant chemotherapy, 2) the tumor is stage T3a or less and without findings of tentacular invasion (INF gamma) by pre-operative biopsy, and 3) pre-operative multiple biopsy is performed as deeply as possible along the prearranged incision line.
Congenital neurogenic bladder dysfunction with spina bifida and sacral dysgenesis manifested itself at middle age is reported. A 48-year-old male who had urinary retention and suprapubic cystostomy one year and a half before in another hospital was seen, asking for removal of the cystostomy. He had never had any neurologic or bladder dysfunction in his childhood and adulthood. X-ray examination revealed a bifid spine and sacral dysgenesis, bilateral hydronephrosis, bilateral VUR and urethral stricture. Uroflowmetry showed a severe dysuric pattern (voided volume 5 ml, residual urine 230 ml) and the cystometrogram revealed a hyperactive bladder. Optical urethrotomy for stricture yielded some improvement i.e. recovery of voluntary voiding with large amount of residual urine. TUR of the bladder neck resulted in almost complete voiding. Cohen's antireflux operation yielded favorable improvement of hydronephrosis. The bladder and renal function remained favorable in the follow-up period of about two years. The clinical course of this patient suggested that his bladder dysfunction was due to late manifestation of congenital neurogenic bladder.
Using electron microscope, distribution of lanthanum tracer in the seminiferous epithelium was evaluated in adult male rats 2, 7, 25 and 53 days after single intraperitoneal injection of 3 mg/kg of CDDP. Lanthanum penetrated beyond the tight junction between Sertoli cells and the maximum penetration around the spermatid was found on the 7th day, when any degenerative changes of seminiferous epithelium were not recognized light microscopically. And 4 weeks pretreatment with Cephalantin and Kallikulein had no effects on this lanthanum tracer penetration around the spermatid. On decreasing this lanthanum tracer penetration after 7 days, some lanthanum was also found around the spermatocytes on the 53rd day but not around the spermatid. It is proposed that lanthanum tracer penetration beyond the Sertoli cell tight junction may be a morphological marker of early Sertoli cell dysfunction after CDDP administration.
A 72-year-old woman with signet-ring cell carcinoma of the urinary bladder treated with total cystectomy is described. The bladder yielded linitis plastica pattern of infiltration similar to that seen in the gastric cancer, i.e., cancer tissue extended almost whole bladder deeply to the serosa, whilst the mucosal surface was only minimally invaded. She received no adjuvant therapy and she is alive without recurrence 8 months after the operation. We review the reported cases and shortly discuss the prognosis and treatment of primary signet-ring cell carcinoma of the urinary bladder.
We treated 30 patients with carcinoma in situ of the bladder via intravesical combination chemotherapy. As an induction therapy 20 mg. mitomycin C on day 1 and 40 mg. doxorubicin on day 2 were instilled into the bladder once a week for 5 consecutive weeks. Patients who achieved complete response were assigned a maintenance instillation of mitomycin C alone every 2 to 4 weeks for 1 year. A total of 19 patients achieved complete response following an initial course of induction therapy and 2 partial responders to initial therapy also achieved complete response after repeated induction therapy, resulting in a 70 per cent over-all complete response rate. Toxicity was considerable with moderate to severe bladder irritation occurring in 20 patients but it was tolerable in the majority. Of 21 complete responses 13 remained free of disease for 6 to 43 months (average of 23 months), 5 had recurrent carcinoma in situ and 1 had invasive urethral cancer. In contrast, of 9 nonresponders 2 and 1 had invasive cancer of the bladder and ureter, respectively.
The drug concentration profile at non-steady state in the intestine was simulated using a laminar flow model. The transport equation with cylindrical coordinates was solved by a finite difference method to stimulate the concentration profile in the tube and the exit cup-mixing concentration. A drug with a various wall permeability coefficient (Pw = zero or 10(-5) to 10(-3) cm/s) and diffusion constant (D = 10(-6) to 10(-4) cm2/s) was assumed to be introduced into the tube in a pulse form. The spatial intervals of the grid and the time step were varied to yield the optimum condition for calculation. The concentration profile in the tube as the time elapsing and the exit cup-mixing concentration versus time profile were shown graphically. Pw and D influenced the concentration profiles. This suggests the possibility of the estimation of Pw and D by determining the exit cup-mixing concentration after a pulse input to a perfused intestine under a laminar flow condition.
Unusual mode of renal duplication may be confused with supernumerary kidney. The presented adult female complaining left flank pain had bilateral duplication of collecting system with ectopic opening in one of the left-sided ureter. Since the ureteral opening to the bladder neck resulted in giant hydronephrosis in the upper half segment responsible for her complaint, surgical resection was performed. The duplication of the left renal mass and collecting system was regarded as "unusual" in several points. First, the lower half segment of the left kidney looked a normal complete kidney, because it had upper, middle and lower calices. Second, the lower half segment was located rather superior to the upper one. Third, the parenchyma of the upper segment which was a rudimentary small mass of several grams was separated from the lower one. But the left renal artery was single, which supplied blood to not only the lower segment but also the upper one, and the two segments were connected tightly each other by loose areolar tissue. These facts prevented to categorize this case as supernumerary kidney. This case suggests that there may be many transitional cases between fused kidney and supernumerary kidney.
Microcystic adnexal carcinoma (MAC) in a 48-year-old Japanese male was studied. A firm nodule had appeared on the right side of his upper lip at the age of 38 years and then had gradually enlarged. Light microscopic examinations revealed numerous strands and islands of basaloid cells and keratinous cysts with desmoplastic stroma in the dermis and subcutaneous tissue. Some keratinous cysts showed early calcification and some contained pilar structures. Clear cells resembling sebaceous gland cells were observed in the strands of tumor cells connecting the keratinous cysts. In the middle dermis, there were small ductal structures containing amorphous eosinophilic material. Immunoperoxidase staining for carcinoembryonic antigen was focally positive in the lumina of small ducts, on the ductal lining surface of tumor cells, and in the contents of keratinous cysts. Electron microscopic examinations revealed tumor cells resembling non-keratotic keratinocytes, and containing tonofilaments, mitochondria, and vacuoles. In some parts, tumors were differentiated to various types of sebaceous gland, sweat duct, or sweat secretary segments. Sebaceous gland cells contained lipid droplets and glycogen. Tumors differentiated to sweat duct had a marked similarity to embryo eccrine duct in the lower epidermis because of the presence of multivesicular dense bodies and periluminal filamentous zones and the absence of myoepithelial cells. Tumors differentiated to sweat secretary segments had a similarity to embryo eccrine secretary segments because of the absence of multivesicular dense bodies, periluminal filamentous zones and myoepithelial cells.
A 54-year-old male with the chief complaint of bilateral flank pain was admitted to our hospital. Blood chemistry test revealed marked azotemia and retrograde pyelogram showed bilateral hydronephrosis with median shift of narrowed ureters. Abdominal CT scan demonstrated a well-defined dense mass around the aorta implicating bilateral ureters. These findings were interpreted as aortic perianeurysmal fibrosis resulting in bilateral ureteral obstruction. On laparotomy, a large hard mass was found in the lower part of aorta, vena cava, common iliac vessels, inferior mesenteric artery and bilateral ureters. Because of the extension of the mass, ureterolysis and intraperitoneal displacement of ureters wrapped with isolated omentum was performed. Postoperative recovery from azotemia and ureteral obstruction was satisfactory. Biopsy specimen of the mass showed marked fibrosis with non-specific inflammation.
A 74-year-old man underwent hydrocelectomy following repeated fluid aspiration, six times during the previous year. Tunica vaginalis was opened after removing about 70 ml of yellow clear fluid and many miliary sized soft papillary tumors were seen inside of the vaginal sac. These tumors were attached to the sac so closely that they were easily rubbed off with a towel. The pathological specimen showed a papillary structure combined with solid sheets of cells. The cells were cuboidal and polygonal with sparse mitotic figures and the nuclei were round or oval with prominent nucleoli. Malignancy was strongly suspected and orchiectomy was performed a month later. Pathologic examination of the operated material showed that the tumor cells invaded into the tunica albuginea, and the diagnosis of malignant mesothelioma was finally made. The patient has remained well with neither recurrence nor metastasis for fifteen months.
We report three cases of urinary extravasation successfully recovered by conservative measures. Two of them were regarded as spontaneous peripelvic extravasation caused by small ureteral stones. After several days' indwelling ureteral catheter extravasation was ceased and the stones were discharged spontaneously in both cases. The other was regarded as spontaneous rupture of the renal pelvis with urinoma formation due to ureteral obstruction by bladder cancer invasion. Intra-arterial chemotherapy, radiation and hyperthermotherapy to the bladder under percutaneous nephrostomy yielded recanalization of obstructed ureter and resolving of urinoma. We shortly review previous reports and discuss the role of diagnosis and treatment.
Thirteen patients who developed malignant progression after frequent recurrence of noninvasive or superficially invasive (Ta or T1) papillary transitional cell carcinoma of the bladder were studied for expression of ABH-antigens in tumor tissues throughout their clinical courses and cryptic Thomsen-Friedenreich antigen (T-Ag) expression in the tumor tissues was examined simultaneously in nine of them. Five patients who experienced recurrent bladder tumors for more than 5 years without any malignant progression were served as control. ABH-antigens in initial tumors were negative in only two of 13 patients developing malignant progression and in two of five controls. Cryptic T-Ag was positive in all patients examined. Recurrent tumors revealed eliminated or decreased expression of ABH-antigens and cryptic T-Ag before malignant progression in, respectively, ten of 11 and six of nine patients with antigen-positive initial tumors. In contrast, recurrent tumor of controls with antigen-positive initial tumors showed neither elimination nor decrease in expression of antigens throughout their clinical courses.
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Clinical courses of 67 patients with carcinoma in situ (CIS) of the urinary bladder during 14 years from 1971 to 1984 were investigated according to the clinical type of CIS and treatment methods. CIS was classified into four types: the primary group included 18 patients who had neither prior nor simultaneous tumors of the urinary tract; the secondary group included 10 patients who had CIS diagnosed subsequent to the treatment of superficial papillary bladder tumor; the concurrent group included 14 patients who had CIS concomitantly with superficial papillary bladder tumor; and the nonpapillary T1 group included 25 patients who presented with CIS with concomitant nonpapillary T1 tumor. As a rule, the initial treatment was conservative (transurethral resection [TUR] or intravesical chemotherapy) for the primary, secondary, and concurrent CIS groups, whereas treatment was radical (total cystectomy or irradiation) for the nonpapillary T1 group. Five-year survival rates of the primary, secondary, concurrent, and nonpapillary T1 groups were 41%, 100%, 49%, and 68%, respectively. Secondary CIS revealed a rather good prognosis, probably due to the early detection of CIS and early application of intravesical chemotherapy when compared to other groups. Except for patients with nonpapillary T1 tumors, the 5-year rate of malignant progression (invasion or metastasis) and multiple recurrences leading to delayed cystectomy was 81% in 16 patients treated by TUR, whereas it was 39% in 21 patients treated by instillation therapy. It appears likely that intravesical chemotherapy was preferable to other conservative therapies as an initial treatment of CIS. Radical therapy, however, may be the choice for CIS with nonpapillary T1 tumors, ab initio.
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