(Backgraund) It is difficult to diagnose intermittent hydroneophrosis and to decide the indication of surgical intervention. We investigated 23 cases of intermittent hydronephrosis. (Methods) From 1978 to 1995, a total of 23 patients were diagnosed as intermittent hydronephrosis in our institution. We inspected their clinical features and treatment which had been performed to them. (Results) Our study comprised 21 boys and 2 girls, whose mean age was 6 year old. Their chief complaint was intermittent flank pain (left: 21, right: 1, bilateral: 1) accompanied with gross hematuria (30%) and vomiting (39%). When they were asymptomatic, an excretory urogram revealed only mild pelvic dilatation without calyceal distension and kinking of ureteropelvic junction. Split renal function study by RI showed no difference between the affected side and the normal side except one case. When pelvic or calyceal enlargement was confirmed on ultrasonography while they were symptomatic, surgery was indicated. Surgery was performed in 17 cases (74%) including dismembered pyeloplasty in 14 cases, resection of aberrant vessel in 1, relocation of lower pole renal vessel in 1 and nephrectomy in 1. In surgical and histological view points, intrinsic stenosis was seen in 10 cases, extrinsic obstruction caused by aberrant vessels was seen in 4 and ureteral polyp was seen in 3 (bilateral polyp in 1 case). (Conclusion) They had no more symptoms after operation. Of 23 among followed up cases without surgery, we experienced 2 cases unexpectedly advancing irreversible hydronephrotic change after the last attack, 1 case of gradually progressing hydronephrotic change and 1 case of severe renal dysfunction after many attacks. Therefore intermittent hydronephrosis should be followed up carefully.
(Background) Nephron-sparing surgery is ideal in the treatment of renal angiomyolipoma (AML). But, in fact, ocasional cases are found in post-ruptured AML and/or in bilateral multiple AMLs, that is seen in tuberous sclerosis. And we cannot perform nephron sparing surgery so easily. We proposed the treatment selection in such complicated AML. (Methods) We experienced 10 cases (12 kidneys) for about ten years, and studied our treatment selection and prognosis on each cases retrospectively. (Results) Of the 5 kidneys with AML less than 4cm in diameter, 4 have not encountered with rupture. Of the 7 kidneys with AML more than 4cm in diameter, 4 kidneys had rupture. Of the 3 kidneys unruptured AML more than 4cm in diameter, 2 kidneys were treated by enucleation and we performed preventive embolization for rupture in residual one kidney. The patients was suffered from tuberuos sclerosis, and she had bilateral multiple AMLs. Of the 4 kidneys with ruptured AML, 2 kidneys were treated by enucleation, and the other 2 kidneys were entirely resected. We succeeded enucleation in 2 of 4 kidneys with ruptured complicated AML. In those cases, we did long term watching after rupture and in-situ perfusion technique at the operation. (Conclusions) Active treatment of AML, that is more than 4cm in diameter, migth be recommended. Because most of those will be ruptured. The ideal treatment, nephron-sparing surgery is difficult in complicated situation, such as after rupture and bilateral multiple AMLs. In our opinion, the point of success of nephron-sparing surgery migth be long term watching after rupture and in-situ perfusion technique at the operation.
(Purpose and Materials) Out of 84 patients with meningomyelocele repaired at birth, 14 (15.7%) children (6 boys and 8 girls, average 8.8 year-old) who underwent cord untethering for tethered cord syndrome of delayed onset (Delayed TCS) were urologically evaluated. (Results) Eleven (78.5%) children were detected orthopedically by deterioration of lower extermities function and only 3 (21.5%) were detected urologically. Preoperative urodynamic study, howerver, reveaeld in 5 children aggravation of urinary tract dysfunction, including accelated uninhibited contraction in 4, impaired bladder compliance in 3, decreased bladder capacity in 2 and recurrence of VUR in 1. Although there were no paticular urinary symptomes for detection of Delayed TCS, acceration of uninhibited contraction seemed to be one of the most important findings. After untethering, deterioration or normalization of urological dysfunction was not seen. Six of 14 children had favorable clinical results, such as improvement of uninhibited contraction, increasing of bladder compliance and capacity, prolongation of dry time and disappearance of VUR. In 3 children Delayed TCS were detected by postoperative improvement of urinary tract function. Consequently, of 14 children who were evaluated preoperatively and postoperatively 8 (52.7%) had urological impairment compatible with Delayed TCS. (Conclusions) It is not easy to detect the urological deteriorations associated with Delayed TCS behind initial neuro-urological deficits. Careful and regular follow-up examinations are required to eary detection of Delayed TCS. The fact that urinary tract dysfunction improved in some cases after untethering encourages agressive surgical untehtering of Delayed TCS.
(Background) Reports on the patiens with chromophobe cell renal carcinoma were very few. Therefore, the clinical features of this disease are uncertain. Based upon this background, we have studied on the clinicopathological characteristics of chromophobe cell renal carcinoma. (Patients and Methods) From 1957 to 1995, seven hundred and fifty-one patients with renal cell carcinoma (RCC) were treated at the Jikei University Hospitals. Of these patients, 36 (4.8%) with chromophobe cell renal carcinoma were diagnosed by histopathological examination. Of these 36 patients, the objective patients were 34 who could be followed-up along with long interval. (Results) The age distribution was 28 to 83 years old (mean was 54.1 years). Regarding to the sex difference, there observed male in 22 patients and female in 12 patients (sex ratio was 1.8:1). Furthermore, the affected side was even, but there observed the symptoms of urinary tract mainly of haematuria in 24 patients (76.5%). As to the laboratory examination, there observed the abnormality of the acute phase reactants in 20% of patients. The greater diameter of the tumour was distributed from 1.5 to 17cm (mean: 6.9cm), and no consistent tendency of tumour localization was observed. Regarding the preoperative angiography, there observed the hypovascular/avascular pattern in 15 patients (44.1%). As to the stage and grade, there observed the low stage patients in 30 (88.2%) and low grade patients in 27 (79.4%). With respect to the prognosis, the 1, 3, 5, 10, 15 and 20 years survival rates for chromophobe cell renal carcinoma were 97.1%, 81.6%, 81.6%, 70.2%, 61.9% and 46.7% respectively. After comparing the survival rate of the same stage and grade patients between the objected patients and the common types of RCC, there observed a favourable prognosis in the patients with chromophobe cell renal carcinoma. Especially in patients with eosinophilic variant, no cancer related death was observed. (Conclusion) The clinicopathological characteristics of chromophobe cell renal carcinoma show the hypovascular/avascular in angiography, low rate of laboratory abnormality, low stage/low grade and a favourable prognosis compared with the common types of RCC.
(Background) We studied on the anti-tumour effects of recently cloned cytokine interleukin-12 (IL-12) for murine renal cell carcinoma (RC-2) with special reference to the difference of its activity based upon the different method of administration. (Materials and Methods) Ten days after RC-2 inoculation to subcutaneous of BALB/C mice, the recombinant murine IL-12 (rMu-IL-12 was administered (0.5 microgram/mouse, 1.0 microgram/mouse and 2.0 microgram/mouse) 5 times per week for 3 weeks. Two administration methods were applied: intraperitoneal administration (i. p.) and subcutaneous administration near grown tumour (s. c.). We evaluated the efficacy of IL-12 for the RC-2 by means of the ratio of relative mean tumour weight (TRW/CRW), the degree of histological degneration and the survival time of tumour-bearing mice. Furthermore, the serial body weight of mice excluding the tumour weight was monitored in order to evaluate the side effect of IL-12. (Results) 1) The ratio of TRW/CRW: As to the experiment of IL-12 injected at 0.5 microgram/mouse, the anti-growth effect was more potent in the i. p. group than in the s. c. group. On the other hand, as to the higher dose groups including 1.0 microgram/mouse and 2.0 microgram/mouse groups, the s. c. groups showed more potent anti-tumour growth effects than the i. p. groups. 2) The histological effect: All examined groups showed the degree of grade II degeneration which meant the existence of viable tumour cells after the treatment had been finished. Furthermore, we found out the different pattern of degeneration between the two administration groups (i. p. and s. c.). Namely, there observed sporadical degeneration in the i. p. groups, and also observed uniform degeneration close to the injected area in the s. c. groups. 3) Survival time: All treated groups showed a significant prolongation of survival compared with the control, but no significant difference was observed between these two different injected groups. 4) Side effects: Through monitoring serial changes of body weight of treated mice, no significant decrease of body weight due to the administration of IL-12 was observed in all experiments. (Conclusion) The anti-tumour effects of IL-12 for murine renal cell carcinoma with special reference to the difference of anti-tumour effect based upon the different method of administration shows that more potent anti-tumor growth effects are observed in the i. p. group dosed at 0.5 microgram/mouse than in the s. c. group. On the other hand, as to the escalating doses, more potent anti-tumour effects are observed in the s. c. groups than in the i. p. groups. Through all treatment groups, no complete regression of the tumour is observed. Therefore, further precise study to clarify the immunological reaction between tumour and its host derived from the administration of IL-12 must be needed in order to establish more effective treatment with IL-12 in the future.
(Purpose) We evaluated the changes in stem cells in peripheral blood and the optimal timing for harvesting peripheral blood stem cells (PBSCs) following the administration of conventional cancer chemotherapy in patients with urological malignancies. (Patients and Methods) We evaluated the changes in PBSCs after the administration of cancer chemotherapy in 12 patieints with urological malignancies (6 testis cancer, 3 bladder cancer, 3 prostate cancer) using flowcytometric analysis of CD34, a marker of blood stem cell. We evaluated the optimal timing for PBSCs harvesting following the administration of conventional cancer chemotherapy in 6 patients with urological malignancies (2 patients with testis cancer, 3 patients with prostate cancer, 1 patient with bladder cancer) using f lowcytometric analysis of CD34 and granulocyte-macrophage colony-forming units (CFU-GM) counts. PBSC samples from 2 patients with prostate cancer were analyzed by the reverse transcriptase-polymerase chain reaction (RT-PCR) method to detect prostate cancer cells. (Results) The percentages of CD34-positive cells tended to increase in the peripheral blood during the period of convalescence that followed the induction of marked myelosupression produced by the cancer chemotherapy. The peak in CD34-positive cells occurred between days 15 and 31 after beginning of cancer chemotherapy. The percentage of CD34-positive cells was increased in the mononuclear cells in harvested PBSCs. The percentages of CD34-positive cells in peripheral blood and in mononuclear cells harvested from PBSCs was correlated with the CFU-GM counts in harvested PBSCs. The CFU-GM counts peaked between days 16 to 31 following cancer chemotherapy. RT-PCR detected prostate-specific antigen (PSA) mRNA expression in PBSCs obtained from 1 of the 2 patients with prostate cancer. An amount of contamination with PSA mRNA reduced as chemotherapy was repeated. (Conclusion) A sufficient number of PBSCs can be harvested after conventional cancer chemotherapy without the need for special cytotoxic mobilization that may be delayed the patient's treatment. RT-PCR results suggested that the harvested PBSCs should be examined for tumor cell contamination in patients with metastasis in bone marrow. If a sufficient amount of PBSCs will be harvested, the PBSC samples from the patient with bone marrow metastasis after repeated chemotherapy should be used by priority for PBSC transplantation as of today.
(Background) The age eligibility for the mass screening (MS) for prostate cancer was investigated. (Methods and Materials) This study was performed in subjects examined by MS from 1981 to 1994 in Gunma Prefecture, Japan. MS was performed by digital rectal examination (DRE) and prostatic acid phosphatase from 1981 to 1991, and by DRE, transrectal ultrasonography and prostate specific antigen from 1992 to 1994. (Results) It was demonstrated that the prostate cancer detection rate was affected by the ratio of subjects newly and previously examined, the age distribution in the group examiend and the diagnostic modality. It was also demonstrated that the detection rate of early stage prostate cancer was also affected by the age distribution and the diagnostic modality. The effective detection rate was determined on the assumption that the purpose of MS is the detection of the subjects who have the indication for the radical prostatectomy, and the effective detection rate was calculated in the range from 50 to 69 years for age eligibility, and B and C for clinical stage. It was estimated that effective detection rate was 0.37 to 0.61%. They were higher than the detection rate of MS for other organ cancers. (Conclusion) The eligibility is 50 to 69 years. If subjects in the range of 70 to 74 are included in this project, it is necessary to make an effort practice a subject-education about the prostate cancer natural history and the radical prostatectomy inidication.
A 32-year-old man was admitted with a sudden onset of severe left flank pain. The abdominal CT and MRI showed bilateral renal tumors with left perirenal hematoma. Selective right renal tumor biopsy under the guidance of ultrasonography revealed that right renal tumor was angiomyolipoma (AML). After performing left renal embolization of the left renal artery, left nephrectomy was performed. The histology of the excised specimen was also AML. This patient had visited to the other clinics in 1985 and in 1988, and was examined by CT. Accordingly, doubling time of this tumor was calculateld by ellipsoid method. Doubling time in 1985-1988 was 231 days, and that in 1988-1995 was 675 days. Growth change of left renal AML did not show exponential curve.
There has been no effective therapy for metastatic renal cell carcinoma (RCC). Cimetidine has been demonstrated to block histamine mediated activation of suppressor T cells in man and in animal models, resulting in an anti-tumor immune response. We treated two patients with cimetidine for matastatic RCC. Case 1: A 61-year-old man presented with a diagnosis of metastatic lung and brain tumor of RCC. Interferon therapy was not effective, but after radiation therapy, his brain metastasis revealed partial response. He received cimetidine 800mg orally after radiation, his lung metastasis revealed almost complete response. But he died of ishcemic heart disease. Case 2: A 58-year-old woman presented with a metastatic lung tumor of RCC. We started interferon therapy. But because of general fatigue and anemia, she required discontinution of interferon therapy. So she received cimetidine 800mg orally and her lung metastasis revealed complete response. She remained well and had no evidence of disease. Patients with metastatic renal cell carcinoma can occasionally respond to cimetidine and further investigation must be studied.