(Background) The object of this study is to evaluate the efficacy of selective renal tumor biopsy in patients with renal cell carcinoma. The accuracy of histological diagnosis and DNA content of biopsies in predicting those of surgical specimens was assessed. (Methods) From 1985 to 1994, 41 patients with renal cell carcinoma underwent selective renal tumor biopsy before partial or radical nephrectomy. DNA content of renal cell carcinoma in 41 patients in biopsy specimens and surgical specimens were examined in paraffin blocks with static cytofluorometry (SCM) and flow cytometry (FCM). (Results) In 39 out of 41 cases, by SCM, as well as in 37 out of 41 cases by FCM, DNA content of biopsy could be analyzed. Findings of selective renal tumor biopsy for RCC coincided with those of surgical specimen in 27/39 (accuracy 69%, kappa 0.398) in cell types, 29/39 (accuracy 74%, kappa 0.432) in structural types, 26/39 (accuracy 67%, kappa 0.341) in gradings and 27/39 (accuracy 69%, kappa 0.532) in ploidy patterns. (Conclusion) It was assumed that DNA histograms might help the histological diagnosis by biopsy.
(Background) This study investigated the feasibility of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the managemant of ureteropelvic junction (UPJ) obstruction. (Methods) Six patients (male: 3, female: 3, age: 6-48) with UPJ obstruction and abdominal pain as the chief complaint, were treated by the Acucise ureteral cutting balloon device (flexible ureteral catheter, 7Fr) under epidural or general anesthesia (for the 6--year-old girl only). After cutting the stenotic area electrically and posteriolaterally using a 3cm cutting wire and dilation by the balloon to a maximum of 24Fr for 10 seconds, a 6/10Fr (for children) or 7/14Fr (for adults) endopyelotomy ureteral catheter was left in situ for 8 weeks after the opeation. After removing the ureteral catheter transurethrally, the results, including the patency of the UPJ, of this procedure were evaluated by intravenous pyelography and the disappearance of the chief complaint, abdominal pain, 12 weeks after removing the ureteral catherer. (Results) Mean operative time was 47 (25-90) minutes and the hospital stay after the operation was 5.3 (3-14, mediam: 4) days. There was no tranfusion or emergent open operation for uncontrolled bleeding in this series. The results 20 months after the operation: improvement of hydronephrosis was shown in 4 patients (66.7%) on intravenous pyelography and abdominal pain disappeared in all patients. (Conclusion) UPJ obstruction may be easily and sefely treated by retrograde endopyelotomy with the Acucise ureteral cutting balloon device. The principal potential adventage of this procedure is reduced morbidity compared to that with antegrade or retrograde endopyelotomy by endoscopy.
(Background) The facilitation of dissecting the vesical pedicles and undisturbed preservation of the membranous urethra were investigated during radical cystectomy using the retrograde technique. (Methods) First, just as with radical prostatectomy, the prostate and the rectum were separated by blunt digital dissection. After the deep dorsal vein complex and the urethra were cut, the bladder and the rectum were also separated in a retrograde manner towards the Denonvillier's fascia. Then the peritoneum was opened and its lowest part was incised above the cul-de-sac. A tunnel was made beginning at the cut-end of the urethra to the cul-de-sac. Consequently, the bladder was lifted up by hand inserted this “vesico-rectal tunnel” and the bilateral remaining lateral pedicles were ligated and transsected without difficulty. (Results) Fourteen patients underwent radical cystectomy using this technique. Among them, the average operating time and blood loss in 4 patients received retrograde radical cystectomy accompanied with ileal conduit were 5 hours 15 minutes and 1606ml, respectively. These in 9 patients received retrograde radical cystectomy followed by bowel orthotopic urinary reservoir were 7 hours and 6 minutes and 1086ml, respectively. Another patient received ureterocutaneoustomy. (Conclusion) Creating a “vesico-rectal tunnel” during radical cystectomy primarily by the retrograde extraperitoneal technique can afford to preserve the urethral sphincter and to ligate the pedicles easily. This method is fundamentally familiar to us because retrograde radical prostatectomy is now widely adopted and it may help to reduce the operating time even when there is a shortage of manpower.
(Purpose) As there is increasing evidence that diabetes induces changes in the plasma levels of endothelins (ETs) and the properties of the ET receptors in peripheral tissues and there are reports indicating the presence of significant amounts of endothelin binding sites in the mammalian vasa deferentia, we studied possible alterations in ET receptor characteristics in the vasa deferentia of rats and rabbits. (Methods) Diabetes was induced with i.v. injections of streptozotocin (65mg/kg) and alloxan (100mg/kg) in rats and rabbits, respectively. We investigated the binding characteristics of endothelin (ET) receptors in the vasa deferentia of four and five month experimentally-induced diabetic rats and rabbits, respectively. The densities and pharmacological properties of ET receptors in the rat and rabbit vasa deferentia were examined by radioligand receptor binding studies using [125I]ET-1. (Results & Conclusion) Receptor binding experiments with [125I]ET-1 revealed a dramatic upregulation in the expression of a single class of specific, saturable, high affinity of [125I]ET-1 binding sites in the diabetic rats but not in the vasa deferentia of diabetic rabbits. ET-1 (non-selective), ET-3 (ETCselective), BQ 610 (ETA selective) and IRL 1620 (ETB selective) compounds inhibited [125I]ET-binding to the rats and rabbits vasa deferentia consistent with the predominance of ETA receptors in these tissues.
(Objective) The purpose of this study was to analyze bladder tumor (BT) associated with renal pelvic and/or ureteral tumor (RUT), with emphasis on the relationship between the grade and stage of these tumors. (Methods) We reviewed 77 cases of RUT operated upon at our hospital during the last 14 years. We herein define stage T1b tumor as invasive since this stage of tumor is considered to have a different biologic behavior and potential compared to stage Ta tumor. (Results) Of the 77 patients, 29 had associated BTs: 8 with a concomitant BT, 3 with BT antedating RUT, and 18 with a subsequent BT. In addition, one patient with preceding BT and two with concomitant cases developed BT after the RUT operation, permitting 21 cases to be categorized in the subsequent BT group. Thirty one out of 32 cases of associated BTs had the same or a lower grade of RUT while one patient who initially had G2 T1b RUT developed G3 T2 BT 5 years after total nephroureter-ectomy. In the preceding cases, two patients with Ta BTs had Ta RUTs, and one patient with T1b BT antedated T2 RUT. In the concomitant BTs, all four cases with stage Ta RUT exhibited Ta BT, and another four with invasive RUT presented invasive BT. In the subsequent cases, 18 out of 21 patients developed Ta BT. (Conclusion) In the preceding and concomitant cases, associated BT & RUT tend to have the same nature, that is, to be either invasive or non-invasive. In contrast to these cases, 18 out of 21 patients in subsequent cases developed Ta BT. However, since three out of 10 patients with invasive RUT subsequently developed invasive BTs, careful follow-up for invasive RUT should be mandatory to detect recurrent invasive BTs in their early stage.
(Background) Telling cancer patients the true diagnosis is inevitable to acquire informed consent especially in the Western world. In Japan, however, no such consensus has been established yet. We investigated the influence of telling the true diagnosis on QOL of prostate cancer patients. (Methods) We measured physical, mental and social aspect of prostate cancer outpatients by the General Health Questionnaire (GHQ) and the international Prostate Symptom Score (I-PSS). Using the general linear models we tried to explore which variables would attribute to “severe depression”, “anxiety and insomnia” and “social dysfunction”. (Results) No significant differences were found in any of the eight variables (age, performance status, clinical stage, I-PSS and Goldberg's four factors of GHQ) among the two groups that were informed the true diagnosis or not. The correlation structures of “severe depression”, “somatic symptoms” and I-PSS are significantly different in the two groups. As a result of the analysis by the GLM, “somatic symptoms”, I-PSS and clinical stages had main effect on “severe depression”. Also, there was an interaction between the effect of telling the true diagnosis and “somatic symptoms”. (Conclusion) These results suggest that the mental condition of prostate cancer patients remain stable when they are in good physical condition regardless of being informed the true diagnosis or not. However, the patients who weren't told the true diagnosis have a tendency to get depression accompanying deterioration of physical condition. It is therefore considered that telling the true diagnosis makes the patients understand the changes of their physical conditions and help their mind to be stable.
A 74-year-old man was admitted to our hospital. Diagnosis of invasive bladder cancer was made and a total cystectomy was performed on January, 30, 1980. Histological examination showed transitional cell carcinoma, grade 2, pTlis N0M0. After 16 years, when he suffered left femur, he had right inguinal lymphnode swelling. On the biopsy of the inguinal mass, histology was transitional cell carcinoma. The urethral washing cytology was positive. Lung CT scan demonstrated multiple lesions. He was diagnosed of the urethral recurrence, right inguinal lymphnode metastasis and lung metastasis of bladder cancer. This case is the 5th case of urethral recurrence of bladder cancer following cystectomy in our hospital.