(Background) It is well known that many diseases may be associated with obesity resulting from an energy-rich diet, and that a westernized diet may increase the incidence of urinary stone formation. To evaluate degree of obesity, we investigated body mass index (BMI) in patients with calcium containing upper urinary stones and examined their blood with regard to lipid metabolism. (Methods) Batween July 1994 and December 1995, we analyzed 332 fresh renal-stone formers (253 males and 79 females) who visited 7 hospitals located in Ehime prefecture. As a control, 949 residents older than 20 years (387 males and 562 females) of the same prefecture were also examined by the annual Ehime prefecture office report of 1994. Body mass index as degree of obesity, stone-recurrence, blood test and other complicated diseases were examined. (Results) In male stone formers the rate of obesity was significantly higher than that of control males (p<0.001). The differences were seen only in their twenties and fifties. Furthermore, among male stone formers the rate of obesity was significantly higher in recurrent stone formers than in single stone formers (p<0.05). On the other hand, in female, there was no significant difference in the rate of obesity between stone formers and controls. No difference was seen between recurrent stone formers and single stone formers. In the blood test, there was no differences in the level of calcium, phosphate and uric acid between stone formers and controls. The level of cholesterol and triglyceride in male were significantly higher in controls (p<0.01) and there was no difference in the level of high density lipoprotein (HDL) between stone formers and controls. Among the stone formers, 48 males (20.0%) and 17 females (21.5%) had other diseases. The rate of complicated diseases was similar to that of controls and no specific diseases in the stone formers were identified. (Conclusion) Our report suggested that obesity in male should be considered as a risk factor for calcium containing stone formation.
(Background) There exists controversy concerning the relationship between the vascular invasion and the prognosis in the locally confined renal cell carcinoma (RCC). We have tried to study on the relationship between the vascular invasion and the prognosis in these patients. (Methods) Of the five hundred and forty-eight patients with RCC who did not have lymph node and distant metastasis, the 464 patients without having the micro- and/or macro-vascular invasion (tumour thrombus) were analysed as the control, and the remaining 85 with micro- and/or macro-vascular invasion were subject to this study. (Results) There observed a significantly favourable prognosis in the patients with RCC who did not have the vascular invasion (pV0) compared with the patients who had the vascular invasion (pV1a: n=43, P=0.00068, pV1b: n=34, 0<P<0.00006, pV2: n=8, P=0.012). Furthermore, the patients with pV1a showed a significantly favourable prognosis compared with the patients with pV1b (p=0.00032), and the patients with pV2 (0<P<0.00006), and the patients with pV1b (P=0.00032), and the patients with pV2 (0<P<0.00006), and the patients with pV1b also showed a significantly favourable prognosis compared with the patiens with pV2 (0<P<0.0006). As to the relationship between the tumour size and vascular invasion (V-stage) the tumour size got larger along with the elevation of the V-stage, and there also observed a significant difference of the tumour size between the patients with pV10 and pV1a (P=0.00578), with pV0 and pV1b (0<P<0.000061) and pV0 and pV2 (P=0.0002). The same result was obtained in the relationship between the localization of the tumour and prognosis, i. e., the patients with pV2 showed a higher frequency of larger occupation of the tumour within the kidney compared with other V-stage patients. Regarding the recurrence rate, there observed a tendency toward high frequency of recurrence along with the elevation of V-stage. Furthermore, there observed an untoward relationship between the elevation of the V-stage and the periods of recurrence after nephrectomy. In an effort to analyse the disease-free survival, there observed a significant difference among the patients with pV0, pV1a, pV1b and pV2. (Conclusion) We conclude that the vascular invasion is a very important prognostic factor in the patients with locally confined RCC. Furthermore, along with the elevation of the V-stage, it directly reflects the poorer prognosis.
(Purposes) Posterior urethral valves (PUV) are the most common cause of mechanical infravesical obstruction in children. It is emphasized that this disorder has broad spectrum of severity, and patients presenting signs and symptoms in neonates or early infancy are at high risks for renal failure. The clinical pictures changed dramatically with the introduction of prenatal diagnosis by ultrasonography (USG). We report on perinatal management of PUV detected by prenatal USG, especially stressing on the significance of early delivery in risky fetuses. (Patients and Method) From 1987 to 1996, we treated 6 patients with PUVs who had been detected by prenatal USG. Fetal hydronephrosis was noticed between 26 to 29 weeks of gestation. Oligohydramnios was apparent at the same weeks of the detection or 2 to 7 weeks later. Fetal conference including obstetrician, neonatologist, anesthesist and urologist was taken place to discuss the date and mode of delivery. Among the patients, 5 were induced early delivery around 30 weeks of gestation. After birth, serum Cr was monitored, and small feeding tube was placed in the urethra. Primary valve ablation was indicatd in 4 patients whose Cr returned to near normal after the urethral drainage. One required upper tract diversion because of the continuous elevation of Cr levels. (Results) Of the patients, one died of respiratory failure from lung hypoplasia. Ventilation support was needed in 3 patients. The patient who required upper tract divesion went into ESRF when he was 6 months old. Except for this patient, renal function improved in 4 patients with nadir Cr levels between 0.4mg/dl to 0.6mg/dl. Transurethral valve ablation was done on 5 patient between 16th to 40th days after birth with the lowest body weight at operation of 1450g. Cystometric studies in neonatal periods showed small capacity, and hypertonic bladder in all patients. Valve ablation and administration of anticholinergics improved bladder function. (Conclusion) Prenatal ultrasonography clearly demonstrate the pathological features of the fetus with PUVs. Because oligohydramnios started in the early 3rd trimester indicates acute renal failure of the fetus, early delivery followed by emergency treatment may salvage the most severe type of this entity.
(Background and Methods) To detect prostate cancer cells in the blood circulation and in the lymph nodes by RT-PCR methods, we examined two kinds of prostate specific antigens (PSA) primers and one prostate specific membrane antigen (PSM). PSa primer 1 was established by us, PSA primer 2 by Moreno et al and PSM primer by Israeli et al. (Results) Both PSA primers were specific for expression of PSA mRNA because in 12 kinds of urogenital culture cells only LNCaP cells, which produce PSA, expressed PSA mRNA by RT-PCR, PSA 1 was more sensitive than PSA 2 for detection of PSA mRNA in the circulating cells since PSA mRNA was detected in the blood circulating cells in 5 cases of stage D2 prostate cancer using PSA primer 1 but in only one was using PSA primer 2. PSM mRNA was detected in all 12 types of urogenital cancer cells and in the blood circulating cells not of prostate cancer patients but also of renal, bladder, testicular cancer patients and normal volunteers. PSA 1 was used to detect PSA mRNA from the samples of fine needle aspiratin biopsy (FNAB) of pelvic lymph node, and PSA mRNA was positive in 10 FNAB samples including not only all 6 cytologically positive and two cytologically class III cases but also 2 of 8 cytologically negative cases. RT-PCR for FNAB samples of all 15 cases of bladder cancer were negative for the detection of PSA mRNA. (Conclusion) Detection of PSA mRNA by RT-PCR in FNAB samples may be useful to diagnose pelvic lymph node metastasis and to furnish additional information for the cytological diagnosis of prostate cancer.
(Background) Radical cystectomy was usually performed for the patient with advanced bladder cancer. The choice of surgical procedure whether bladder preservaed therapy or radical cystecotmy has sometime plagued us in bladder cancer treatment. Because we don't have clear guideline for the treatment of locally advanced bladder cancer (T2-T3a N0M0). We devised a radical treatment for the patients with locally advanced bladder cancer without radical cystectomy. (Patients and Methods) We performed re-TUR treatment after 3 weeks of initial TUR for 13 patients with grade 2 and locally advanced bladder cancer diagnosed with pelvic CT scan, transurethral ultrasonography or bimanual examination under the anesthesia. (Results) We could successfully preserve all cases of bladder with the use of this devised TUR (periods 9-45 months median 22 months). This method has significantly reduced the cystectomy rate in such locally advanced cases compared with the cystectomy rate prior to 1993 (p<0.001). (Conclusion) This method has significance on treatment for locally advanced papillary bladder cancer as bladder preserving therapy with careful observation.
(Background) A total of 110 patients, in whom kidneys from 95 living related and 15 cadaver donor, had experienced renal transplantation between February 1985 and October 1996 in our clinic. This study was conducted to evaluate the influence of the various pre-operative factors to the graft survivals and clinical course of patients in living related renal transplantation. (Methods) In 95 recipients, 17 adult patients had long term graft survivals over 5 years including 6 recurrent or denovo nephritis without chronic allografts nephropathy. Eight failed to graft loss attributed to chronic allografts nephropathy diagnosed within 5 years. Retrospective analysis were performed to elucidate the differences of these recipients. (Results) Donors of long graft survival recipients were younger (49.1±12.1 v. s. 58.9±10.2) and had a better renal function evaluated by preoperative creatinine clearance in living related donors (115.5±37.0 v. s. 79.7±22.0l/day). Graft long survival recipients had experienced less frequencies of acute rejection within 6 months (0.53±0.62: 8 patients, 9 times) compared with chronic allografts nephropathy recipients (1.00±0.53: 7 patients, 8 times). Long graft survival recipients had better responses to the antirejection therapy. Additionally acute rejection over 6 months were experienced only in chronic allografts nephropathy recipients. Higher serum creatinine level was revealed in recipients with chronic allografts nephropathy at 1 year after transplantation (1.27±0.27 v. s. 1.88±0.42 mg/dl). (Conclusions) We concluded that donor age and renal function are related to the graft long survival as background factors. Long graft survival recipients had less frequency of acute rejection and good response to the antirejection therapy. In recipients with of acute rejection and good response to the antirejection therapy. In recipients with chronic allografts nephropathy, serum cretine level had already increased gradually within 1 year.
We report a case of small cell carcinoma of the kidney in a 61-year-old female. Chief complaints were left lumbago, gross hematuria and high fever. The computed tomography revealed a large invasive tumor in the left renal pelvis with renal pedicle lymph nodes swelling. Systemic chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) showed a considerable effect and left nephrectomy was performed. But she died within 3 months postoperatively. Histologically, the tumor was composed of hyperchromatic small cells with increased N/C ratio. Immunohistochemical studies revealed positive staining for chromogranin A, synaptophysin, NSE, EMA, cytokeratin, and argyrophilic (Grimelius) silver impregnation stain. Electron microscopy revealed neurosecretory granules also. In conclusion, the present case was diagnosed as small cell carcinoma of the kidney with only 12 similar cases reported in the world literature.
A 45-year-old woman with a history of right flank regional dull pain was referred to our hospital for evaluation of right hydronephrosis. CT and MRI showed a solitary mass (1×1cm, L1-L2 level) at the right upper ureter. Laboratory data were within the normal range. A right nephrectomy was carried out under a clinical diagnosis of primary right ureteral tumor. The pathohistological diagnosis of surgical specimen was plasma cell type of Castleman's disease. One year after surgery, the patient was rehospitalized for azotemia and left hydronephrosis. Abdominal CT revealed a solitary mass (1.5×1.5cm) located at left upper ureter similar to that on her right side. We diagnosed that the mass lesion was due to asynchronous Castleman's disease, so we performed steroid therapy. After the treatment, mass had disappeared. The patient is uneventful for two years. This is the first case reported in the Japanese literature describing Castleman's disease occurred around the bilateral upper ureters.
We here report a case of the gradual maturation of teratoma during 8 years after the initial chemotherapy. A 21-year-old man was diagnozed as having a left testicular tumor with retroperitoneal lymph node metastasis around the left renal artery in 1988 and high inguinal orchiectomy was carried out. Histological examination revealed a mixed germ cell tumor composed of immature teratoma, embryonal carcinoma, and seminoma. He received four courses of PVB chemotherapy for his bulky lymph node metastasis. After normalization of the alpha-fetoprotein level, retroperitoneal lymph node dissection (RPLND) was performed. However, the nodes could not be dissected completely because of severe adhesions to the aorta. Histological examination revealed massive necrosis and immature teratoma. One couse of combination chemotherapy with cisplatin and etoposide was given following the surgery. In 1991, enlargement of the residual lymph nodes around the left renal artery was dectected by CT scanning. Since both PVB chemotherapy and the combination of cisplatin with etoposide did not achieve remission, RPLND was performed again. Histological examination revealed a mature teratoma which was far more differentiated than that resected in 1988. In 1996, several enlarged para-aoritc lymph nodes were found without the elevation of tumor makers, and en-bloc RPLND was performed. Microscopically, mature teratoma was observed in almost all specimens and, unexpectedly, adenocarcinoma was also observed in enteric elements of the mature teratoma. We concluded that we could not evaluate the malignant biological characteristics of teratoma from its maturation level and residual retroperitoneal teratomas should be as completely resected as possible.