(Background) Steroid hormone replacement and recovery of adrenal function after unilateral adrenalectomy were studied in 12 patients with Cushing's syndrome due to adenocortical adenoma.
(Patients and Method) The patiens were 3 males and 9 females aged 19 to 61 years old (mean 34.3 years old). Recovery of adrenal function was judged by plasma cortisol level and rapid ACTH test peridocally.
(Results) Plasma cortisol level was 13.7 to 20.8μg/dl without diurnal rythme before adrenalectomy. Average replacement period with low dose hydrocortisone was 15±9.2 months after adrenalectomy. Plasma ACTH and cortisol concentration was recovered to normal range after 3.4±2.9 months and 12.2±8.2 after adrenalectomy, respectively. Plasma ACTH concentration was recovered to normal range earlier than plasma cortisol level in all patients. Sufficient response of plasma cortisol concentration in rapid ACTH test was seen a little later than recovery of plasma cortisol level.
(Conclusion) Present data suggest that it is insufficient to judge recovery of adrenal function only by the rise of plasma ACTH and/or cortisol concentrations. Therefore rapid ACTH test is useful to judge sufficient recovery of adrenal function during and after steroid hormone replacement.

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(Background) Clinical Features of double cancers associated with renal cell carcinoma (RCC) detected at the clinical course, especially focusing on the comparative analysis between the male and female patients, were unknown. From this background, we tried to search for clinical characteristics of double cancers associated with RCC.
(Patients) The eight hundred and four patients with RCC have been treated at our University Hospitals and affiliated hospitals, and of them, the 38 patients (male in 25, female in 13) had double cancers during the clinical course, and these patients were objective in our study.
(Results) 1) When we looked at all patients, there observed gastric cancer most frequently in 14 (36.8%), lung cancer in 3 (7.9%), prostate cancer in 3, bladder cancer in 3, uterine cancer in 3, rectal cancer in 2 (5.3%), thyroid cancer in 2, and pharynx, esophagus, T-cell lymphoma, chronic lymphatic leukaemia (CLL), renal pelvis, sigmoid colon, brain and colon cancers in 1 (2.6%) respectively.
2) As to the male patients, there observed 10 gastric cancers, of them, 2 died of this disease (20%), 3 lung cancers, of them, 2 died of this disease (66.7%), 3 prostate cancers, of them, 2 died of this disease (66.7%), 3 bladder cancers, of them, 1 died of this disease (33.3%), and 1 cancer patient with pharyx died of this disease, esophagus, T-cell lymphoma, CLL, renal pelvis and sigmoid colon died of this disease. Regarding the female patients, there observed 4 gastric cancers, all of them died of this disease, 3 uterine cancers, all of them died of this disease, 2 rectum cancers, all of them died of this disease, 2 thyroid cancers, of them, 1 died of this disease, 1 brain cancer and 1 rectal cancer. Furthermore, as to the timing at the detection of double cancers during the clinical course, the 10 patients (40%) detected double cancers simultaneously in male patients. On the other hand, no patient with double cancers was detected simultaneously in female patients.
(Conclusion) The gastric cancer is most frequently observed as double cancer in both of male and female patients with RCC. But, in the female patients, it shows more frequently died of double cancers associated with RCC compared with those in male. Furthermore, as to the timing at the detection of double cancer is asynchronous in all female patients with RCC.

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(Objectives) Prognosis and related factors were analysed as for the patients with locally invasive bladder cancer who underwent total cystectomy and pelvic lymphnode dissection.
(Methods) Between January 1977 and December 1996, a hundred and one patients with locally invasive bladder cancer underwent total cystectomy and pelvic lymphnode dissection at University Hospital. Survival rates of these patients were calculated by Kaplan-Meier method and statistical significances were analysed by univariate and multivariate analyses.
(Results) Most significant factor was PS at cystectomy and pN was next. Survival rate of the patients who underwent total cystectomy after 1988 showed significantly better than others. Thirteen patients achieved complete response by preoperative therapy.
But, two of them who had positive nodes were died by cancer.
(Conclusion) Considering from these results, performance status at cystectomy and lymphnode metastasis are predictable prognostic factor for locally invasive bladder cancer patients.

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(Background) In this paper, we reported nephron sparing surgery for renal mass in our hospital.
(Methods) From March, 1994 to October, 1997, nephron sparing surgeries were done for 19 (11 males and 8 females, whose age were ranged from 38 to 75 years old) renal mass in our hospital. The sites of lesion were 12 in right side and 7 in left side. The tumor size were from 8 to 40mm. Almost all cases were discovered incidentally.
(Results) In all 19 cases, 6 cases were resultingly renal cell carcinoma (RCC). There was no difference in age, sex, tumor size and computed tomography findings between RCC and benign lesion. In magnetic resonance imaging (MRI) findings, iso intensity lesions of T2-weighted image were more frequent in RCC significantly. Postoperative 24 hours creatinine clearance and serum creatinine were not changed significantly compared with preoperative data.
(Conclusion) In MRI findings, iso intensity of T2-weighted image was useful for differential diagnosis between RCC and benign lesion.

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(Background) In order to change the immunological environment of T-helper2 (Th2) predominance, namely humoural immunity, in renal cell carcinoma, we tried to examine the efficacy of combined treatment with DNA-methyltransferase inhibitor (Procainamide) and interferon (IFN)-α/β in basic experiments, and also examined the immunological mechanism induced by this treatment modality.
(Materials and Methods) The monotherapy of Procainamide (10mg/kg, 20mg/kg, 30mg/kg, everyday for 3 weeks, i. p.) and of natural murine IFN-α/β (1×10⁴ I. U./mouse, 3 times for a week, total 9 times, s. c.), and combined treatment with these 2 drugs for mouse spontaneously arose renal cell carcinoma (RC-2) were undertaken. Furthermore, we examined the expression of cytokine mRNA related to the Th-subset in murine spleen under the tumour burden by the RT-PCR methods.
(Results) 1) Regarding the anti-tumour efficacy of two kinds of monotherapy (Procainamide and IFN-α/β), no effective result was obtained. On the other hand, the combined treatment with these two drugs induced effective anti-tumour efficacy in the relative mean tumour weight ratio (T_RW/C_RW), mean tumour weight and the survival rate compared with the control and each monotherapy, especially in the administration of Procainamide dosed at 30mg/kg. As to the histological degeneration induced by the combined therapy, there still remained the viable tumour cells (grade IIb). 2) In an effort to analyse the immunological changes induced by the administration of Procainamide, there observed the expression of Th1-derived cytokines mRNA such as IFN-γ, IL-2 and tumour necrosis factor-β, and except for interleukin (IL)-10, there also observed the disappearance of Th2-derived cytokines mRNA such as IL-4, IL-5 and IL-6 in the murine spleen.
(Conclusion) We draw the conclusion that the treatment with DNA-methyltransferase inhibitor may change the humoural immunological environment into the cellular immunological environment enabling the effective anti-tumour efficacy combined with IFN-α/β in renal cell carcinoma.

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(Purpose) We tried to clarify the role of fibroblast growth factors (FGFs) and those receptors (FGF-Rs) in cell proliferation of human prostate cancer.
(Methods) The mRNA expression of FGF1, FGF2, FGF7, FGF-R1, FGF-R2 (IIIb), and FGF-R2 (IIIc) was investigated by RT-PCR in androgen sensitive cells (LNCaP), androgenindependent cells (PC3) and primary cultured stromal (PS) and epithelial cells (PE) from benign prostatic hyperplasia (BPH). Expression of the mRNA of FGF-R1, FGF-R2 (IIIb) and FGF-R2 (IIIc) in human prostate cancer tissue was similarly analyzed. Furthermore, the level of FGF-R1 expression in human prostate cancer was measured by semi-quantitative RT-PCR.
(Results) FGF-R1 mRNA was detected in LNCaP, PC3 and the primary cultured stromal cells of BPH. FGF-R2 (IIIb) was seen in LNCaP cells and the primary cultured epithelial cells of BPH, while FGF-R2 (IIIc) was only obsereved in PC3. FGF1 mRNA was expressed in LNCaP and PC3, while FGF2 mRNA was in PC3 alone. The expression of FGF7 mRNA was detected only in the primary cultured stromal cells. Of 17 patients with human prostate cancer, FGF-R2 (IIIb) was detected in 2 and FGF-R2 (IIIc) in 15. Histological type of two cases having FGF-R2 (IIIb) were well differentiated adenocarcinoma. The mRNA levels of FGF-R1 in poorly and moderately differentiated types were significantly higher than those in well differentiated ones (p<0.05).
(Conclusion) These findings suggest that several changes of expression in FGFs and FGF-Rs may correlate with malignant progression of human prostate cancer.

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A 51-year-old male of von Recklinghausen's disease presented with huge retroperitoneal hematoma caused by spontaneous arterial rupture. He died of uncontrollable hemorrhage during the operation. Gross appearance of aorta, renal artery, celiac artery, pulmonary artery and lumbar artery were extremely fragile, and there was a complete rupture between aorta and lumbar artery. On the microscopic examination, significant medial dysplasia were demonstrated in these arteries. Arterial stenosis is well-known vascular complication in von Recklinghausen's disease. Spontaneous rupture of major artery, however, has been extremely uncommon. This is the 26th case reported in the world literature, and 21th case in the Japanese literature.

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We report a case of tuberous sclerosis associated with bilateral renal angiomyolipomas (AMLs), pulmonary lymphangioleiomyomatosis (LAM) and subungual fibroma of hands and feet. A 42-year-old woman who was diagnosed as tuberous sclerosis at the age of 18 complained of left flank pain and abdominal fullness. Bilateral renal AMLs were pointed out when complete examinations were performed for hypertension at the age of 32. She suffered from severe left flank pain and abdominal distension due to the left renal tumor. Left nephrectomy and excision of the renal hilar tumor were performed. The left renal tumor weighed 1120g, the perirenal space was filled with the tumor. Histopathological diagnosis of the left renal tumor and renal hilar tumor was AML. In our case, bilateral pneumothorax appeared, and chest CT scan revealed bilateral multiple pulmonary cysts. Histopathological diagnosis of pulmonary cysts was LAM. Other complications of our case are intracranial calcification and adenoma sebaceum.

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A 19-year-old male visited our clinic with the complaint of lower abdominal distention, January 1992. He had undergone living renal transplantation from his mother as a donor on June 15, 1988. But the transplanted kidney had become functinal loss by chronic rejection 3 years after transplantation. The computed tomography showed huge low density mass around the nonfunctioning transplanted kidney. En block resection of the tumor and the transplanted kidney was performed. The tumor was pathologically diagnosed as mixoid liposarcoma. It was proved that the tumor cells were derived from recipient cells by the investigation of HLA-DRB1 DNA typing.

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