(Objectives) We investigate the biochemical control rates and adverse events for local and locally advanced prostate cancer patients undergoing high-dose-rate brachytherapy with external beam radiotherapy (EBRT+HDR-BT) in our institute. (Patients and methods) From May 2004 through March 2010, 154 patients with local and locally advanced prostate cancer underwent EBRT+HDR-BT. One hundred thirteen patients with more than 6 months follow-up were evaluated. A median follow-up was 33 months. The patients consisted of 12 low-, 65 intermediate- and 36 high-risk patients. No patients received adjuvant androgen deprivation therapy with EBRT+HDR-BT. Biochemical freedom from failure (bFFF) was determined using the Phoenix definition. (Results) The 5-year bFFF rate was 100%, 94.7%, and 59.2% for low-, intermediate- and high-risk patients. The 58-month bFFF rate of high-risk patients with one ominous factor was significantly lower than that of high-risk patients with more than ominous two factors (87.4% vs 26.9%, p=0.022). With respect to acute adverse events, transurethral electric coagulation was performed for vesical bleeding and tamponade after removal of applicator needles in only one patient. Regarding late adverse events 14.2% of patients had grade 3 genitourinary toxicity, mostly consisted of urethral stricture and 0.9% of patients had grade 3 gastrointestinal toxicity. (Conclusions) EBRT+HDR-BT without adjuvant androgen deprivation therapy yields excellent bFFF in low- and intermediate-risk prostate cancer patients. However, to challenge higher bFFF rate in a part of high-risk patients and lower rate of adverse events, modified designing protocols and therapeutic plannning of EBRT+HDR-BT may be necessary.
(Objectives) The purpose of this study was to retrospectively analyze the characteristics of patients with retroperitoneal sarcoma and to examine pathological findings, first site of recurrence and recurrence free-survival after surgery. (Methods) From June 2003 to May 2010, we performed 10 surgeries for retroperitoneal sarcomas. We chose 9 tumors after excluding 1 tumor that had already disseminated in the abdominal cavity. We examined patient characteristics, pathological findings and the first site of recurrence (local or distant metastasis). We also analyzed recurrence-free survival after surgery with the Kaplan-Meier method. (Results) The patients' median age was 60 years (31-71 years), and the median tumor diameter was 10.0cm (2.7-45cm). Pathological diagnosis revealed 7 cases of dedifferentiated liposarcoma and 2 cases of leiomyosarcoma. En-block resection with adjacent organs was achieved in 8 of 9 patients. During follow-up, 5 of 9 patients experienced tumor local recurrence. There were no cases in which distant metastases appeared before local recurrence. The median duration between surgery and local recurrence was 13 months (3-27 months). The median duration from surgery to death was 30 months (5-78 months). (Conclusions) Although we resected adjacent organs together when we could not achieve a sufficient margin, the rate of local recurrence after surgery for retroperitoneal sarcoma was high. Given this result using treatment with surgery alone, it is necessary to prospectively establish multimodal treatments with chemotherapy and radiotherapy to reduce local tumor recurrence.
A 20 year-old man presented to emergency room with severe left-sided flank pain. Urinalysis showed hematuria and he was referred to the urology department. KUB, DIP and retrograde pyelography (RP) revealed multiple renal stones, left hydronephrosis (grade 2) and ureteropelvic junction obstruction (UPJO). Abdominal CT revealed shortened nutcracker distance and renal angiography showed left renal vein hypertension. From these findings, diagnosis of nutcracker syndrome was made. Transposition of the left renal vein, dismembered pyeloplasty and left pyelolithotomy were performed simultaneously. 2 months after the procedure, his symptom and hematuria disappeared. 3 months after the procedure, DIP revealed improvement of hydronephrosis (grade 1) and CT showed elongation of nutcracker distance. In 12 months follow-up, there was no recurrence of symptom and hydonephrosis. To the best our knowledge, there has been no report of UPJO associated with nutcracker syndrome and the simultaneous treatment for the both diseases.
Primary small cell carcinoma of the renal pelvis is a rare and aggressive disease; reportedly, a mean survival is only 8 months. A 78 year-old woman with chronic kidney disease was referred to our hospital complaining of asymptomatic gross hematoturia. On imaging studies and voided urine cytology, diagnosis of right renal pelvic cancer (cT2N0M0) was made. She underwent total nephroureterectomy. Pathological diagnosis was small cell carcinoma, infiltrating into the renal parenchyma, with lymphovascular invasion. Post-operatively, hemodialysis was introduced. Five months after the operation, new lesions developed in the right adrenal gland, aortocaval lymph nodes and subcutaneous layer of the right back. The subcutaneous mass was surgically removed and low-dose chemoradiotherapy (Σ45Gy/25 Fr/32 d+cisplatin 10mg/d for 2 d×2) was given to the other lesions. Although the lesions regressed to CR, new small masses emerged in the muscle layers of the right flank 14 months after total nephroureterectomy. Low-dose chemoradiotherapy (Σ40Gy/20 Fr/29 d+cisplatin 10mg/d for 2 d×2) to these lesions successfully brought CR. She is alive without any evidence of disease at 3 years after total nephroureterectomy.
A necrotizing fasciitis especially caused by group A streptococcal infection is a life-threatening disease. This infection cause death due to septic shock and multiple organ failure in a short time without the immediate and adequate treatment. Currently a rapid test kit for streptococcal pharyngitis (strep A) is useful for prediction of group A streptococcal infection. We here demonstrate a 61 years old man's case of life-saved necrotizing fasciitis in genital area (Fournier's gangrene) by group A streptococcus infection, and usefulness of this kit for rapid diagnosis, aggressive debridement, and selection of adequate antibiotics.
We encountered a case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled rectus abdominis muscle flap (pedicled RA m-c flap). A 75-year-old man was admitted with consciousness disorder and swelling of the scrotum. The patient had noticed swelling of the scrotum 4 days before admission, but he had ignored this condition. The scrotum and the penis appeared necrotic. On the basis of clinical and radiological findings, we diagnosed this condition as Fournier's gangrene. Surgical debridement was performed in conjunction with the use of broad-spectrum antibiotics. After the patient's general condition was improved, the broad defect in the perineal tissue was covered with a pedicled rectus abdominis muscle flap. The flap was successful. In Japan, this is the first case of Fournier's gangrene complicated with vesicorectocutaneous fistula that was treated with a pedicled RA m-c flap. In order to determine whether plastic surgery after debridement shortens the duration of hospitalization, we reviewed the cases of 120 patients with Fournier's gangrene in Japan. We conclude that plastic surgery after debridement does not shorten the duration of hospitalization, however, this procedures is very useful to deep and broad defects by Fournier's gangrene.
This is a case of repeated acute abducens nerve palsy following prostatitis due to prostate biopsy. A 64-year-old man came to our hospital because of high prostate specific antigen (PSA; 25ng/ml) on routine medical examination. Transrectal prostate needle biopsy revealed atypical small acinar proliferations in two cores taken from the apex of the prostate. One day after biopsy, the patient presented with chills and a fever. Prostatitis due to prostate biopsy was diagnosed, and hydration and intravenous antibiotics were administered. Although he showed signs of improvement, seven days after biopsy, he complained of double vision in the left gaze. Upon referral to the neurology, head MRI and CSF examination showed no particular abnormality. He was thus diagnosed with post-infection abducens nerve palsy and treated with steroid therapy. His symptoms gradually ameliorated. One year after biopsy, his PSA level was still high, although follow-up prostate biopsy was benign. One day after follow-up biopsy, he presented again with chills and a fever. He was retreated with hydration and intravenous antibiotics. Six days after follow-up biopsy, he complained of double vision in the left gaze as in the previous year. With the diagnosis of post-infection abducens nerve palsy, he was retreated with steroid therapy.