(Background) We studied the cases with T 4 renal cell carcinoma (RCC) to characterize the factors associated with prolonged survival and to clarify the indication of extended nephrectomy. (Materials and Methods) The study population consisted of 53 patients (44 male and 9 female) with pT 4 RCC treated at the Yokohama City University Hospital and its affiliated hospitals from 1965 to 1994. Survival rates were analyzed with respect to clinicopathological factors (patient age, sex, symptom, tumor growing type, tumor size, histological grade, cell type, structural type, lymphnode metastasis, vein invasion, distant metastasis and extended nephrectomy). (Results) One-year, 2-years, and 3-years survival rates of the cases with T 4 RCC were 30.4%, 16.4%, and 9.4% respectively. In univariate analysis, improved survival were correlated with no extra-urinary symptom (Logrank: p=0.0048, Wilcoxon: p=0.0423), no lymphnode metastasis (Logrank: p=0.1045, Wilcoxon: p=0.0199), no distant metastases (Logrank: p=0.0007, Wilcoxon: p=0.0006), and enforcement of extended nephrectomy (Logrank: p=0.0018, Wilcoxon: p=0.0008). In 28 cases with extended nephrectomy, improved survival was correlated with no extra-urinary symptom, no abdominal wall invasion and no distant metastases. In 5 cases with more than 3 year survival after extended nephrectomy, 4 cases were found to have no distant metastases at the time of operation. Non-operative therapy including interferon for 20 cases without extended nephrectomy were almost ineffective. (Conclusions) These results indicate that if curative excision for T 4 RCC cases without distant metastases could be done, some patients might be approriate candidates for extended nephrectomy.
(Background) Experimental autoimmune orchitis (EAO) has been studied as an animal model for human immunological male infertility. We have already reported the induction of contralateral EAO (“sympathetic orchitis”) by unilateral testicular injury in mice. In this paper, we report the induction of autoimmune infertility in such mice as well as EAO. (Methods) Ten to 20 needle punctures were made to the unilateral testis of mice and it was crushed by a needle-holder. Such mice were mated in vivio with female mice. (Results) Fifity to 80% mice whose tesitis was injured unilaterally became infertile in 3 months. Delayed type hypersensitivity (DTH), one of the cell-mediated immunities, to autologous testicular cells (TC) as well as anti-TC antibodies, humoral immunity, were both detected in those mice. (Conclusion) We have clearly shown that unilateral testicular injury could induce not only the contralateral EAO but also autoimmune infertilitry in mice. Our present injury model mimics clinical testicular trauma; therefore, this testicular injury model can be very useful in studying the immunological mechanism of EAO and of human immunological male infertility.
(Purpose) Psychogenic lower urinary tract dysfunction (PLUTD) is composed of two syndromes; psychogenic frequency-urgency syndrome (PFUS) and psychogenic urinary retention (PUR). We evaluated the patho-physiology of PFUS and PUR, and explored the different pathogenesis in these syndromes. (Material and Methods) Forty five patients with PLUTD, consisting of 23 patients with PFUS and 22 patients with PUR were investigated by using the psychological tests; CMI (Cornell Medical Index) and TEG (Todai's Egogram), a quantitative perspiration test in 45 females (23 patients with PFUS and 22 patients with PUR), and simultaneous measurements of voiding cysto-urethrography and urodynamic studies using the Life-Tech 6 channel polygraph in 35 patients (17 patients with PFUS and 18 patients with PUR). (Results) The prevalence in ages revealed two peaks, 20 years and 50 to 60 years. Over 25% of them had pyuria more than 10/hpf of WBC. Peak flow rate measured by uroflowmetry showed normal range in PFUS group and decreased in PUR group. The functional vesical volume was less thas 100ml in most patients with PFUS. Residual urine in PUR group was significantly greater. Capacity of the PFUS group were able to hold over 400ml of contrast instilled through the urethral catheter, despite increased desire to void. Over 15% of the study group with PFUS showed uninhibited systolic contraction of detrusor (>15 cm H2O) during filling phase. The measurement value of urodynamic parameters demonstrated that a periodic follow-up survey of the upper urinary tract should be performed because of the low compliance bladder in the patients with PLUTD. During voiding phase, the women with PFUS had a tendency to be divided into two groups, hypercontractile or acontractile detrusor. The voiding cysto-urethrography (VCUG) showed a tendency of bladder neck opening on patients with PFUS during filling phase. Most of PLUTD cases demonstrated a round to triangle shape on vesical configuration, which led to a spastic condition of detrusor muscle. We attempted to measure the quantitative perspiration using 3 kinds of loading tests; respiratory, arithmetic and psychological load. In the psychological loading test, we asked 98 questions about their daily lives including occupation, living condition, family relationship and sexual activities. Arithmetic loading test consisted of counting in reverse, subtraction and multiplication. The quantitative perspiration rate resulted in a “positive” in many patients with PFUS. Respiration loading test was performed to measure the respiration volume during 3 large inhales. Most patients with PUR tested within the normal range for respiration except for those patients with decreased or no perspiration during the psychiatric loading test. These results may reflect the psychological elements including suppression and subconscious defense mechanism. Neurosis which was diagnosed as having type III to type IV of the Cornell Medical Index was demonstrated in less than under 40% of patients with PFUS and more than 55% patients with PUR. There was no significant trend or difference between PFUS and PUR detected from Todai's Egogram. (Conclusions) Due to the reflection of many psychological responses, it is necessary to investigate from various examinations including psychological, autonomical and classical urological studies for accurate diagnosis of PLUTD.
(Objectives) Combined androgen blockade (CAB) uning LH-RH agonist and flutamide has been performed as neoadjuvant therapy for T 2, 3 prostate cancers (CaP). The histological effects of neoadjuvant CAB therapy and influential factors were investigated. (Methods) Metarials were 20 CaP cases which were underwent radical prostatectomy (RP) after neoadjuvant CAB therapy. All cases were diagnosed by echo-guided sextant needle biopsies. RP was performed after serum PSA was decreased to undetectable level. Histological effect was evaluated by general rule for clinical and pathological studies on prostate cancer (Japanese Urological Association). All cases were divided 2 groups by histological effects as follows; Group A (poor effect group): G 0 and G 1, Group B (good effect group): G 2 and G 3. Immunostaining of p 53 (mutant type), bcl-2 and Chromogranin A (ChA) were performed for both pretreatment needle biopsy and RP specimen. In addition, pretreatment serum PSA and Gleason grade were also investigated. (Results) Down grading were found in 30%. Down staging were found in 35% (7 cases). All 7 cases were negative surgical margins and 5 of 7 were clinical T 3. Negative bcl-2 of biopsy specimen was correlation with down grading (p=0.008). In the histopathological evaluation, G 0 was 1, G 1 were 10, G 2 were 6 and G 3 were 3 cases. Gleason 4 or 5 elements of biopsy were found in 9/11 cases in Group A but only 3/9 cases in Group B (p=0.027). The bcl-2 positive cells of biopsy were found in 8/11 cases in Group A but only 1/9 cases in Group B (p=0.006). The p 53 and/or bcl-2 positive cells of biopsy were found in 10/11 cases in Group A but only 3/9 cases in Group B (p=0.007). Serum PSA and ChA were not correlation with histological effect of neoadjuvant CAB therapy. But, in 3 cases, ChA positive cell appeared after neoadjuvant therapy. (Conclusions) We could not expect more than 50% cases to show the down grading and down staging. But, in T 3 case, surgical failure could be decrease. We could expect prostate cancer cases without positive bcl-2 cells, p 53 over expression and Gleason 4·5 to reveal the good histological effects of neoadjuvant CAB therapy.
(Background) The effect of endoscopic injection of collagen was assessed in spina bifida patients with vesicoureteral reflux (VUR). (Methods) Endoscopic collagen injection was carried out for grade II or worse VUR according to the international classification. Twenty-two ureters were studied in 6 boys and 8 girls (mean: 14.4 years) who were followed up over a period of at least 3 months (mean: 5 months) after surgery. they all had a negative preoperative skin test for collagen and were investigated radiologically and urody-namically. Cystograpy was performed 1, 3 and 12 months after surgery and thereafter once a year to detect recurrence of VUR. (Results) Anesthesia was not necessary in 4 patients. No adverse reactions occured to the injection of collagen. VUR disappeared after 1 and 2 collagen injections in 17 (77%) and 2 (9%) ureters, respectively. The therapeutic effect of the single collagen injection showed no relationship to shape of the ureteral orifice, grade of VUR, compliance of the bladder, and presence of detrusor hyperreflexia. (Conclusions) Endoscopic treatment of VUR with collagen injection in spina bifida patients is a simple and less invasive method. We obtained satisfactory short-term results by this method. However, since the risk factor of recurrence remains unclear, sufficient investigation of long-term results is important to determine the role of this method in the treatment of VUR in patients with spina bifida.
(Purpose) Development and characterization of monoclonal antibodies which recognizes a new prostate-organ specific antigen. (Method) For development of monoclonal antibodies, hybrid cells were prepared by fusion of spleen cells of BALB/c mice immunized with the homogenates of surgically resected prostatic tissue and P3×Ag8 U1 (P3 U1) murine myeloma cells. Supernatants of hybrid clones were primarily screened using an ELISA on human prostatic cancer cell line PC-3 and human bladder cancer cell line T-24. In the secondary screening, they were tested on normal tissues by immunohistochemical staining. To characterize the antigens, biochemical analyses were performed using seminal plasma as an antigen by western blotting and gel filtration, and the reactivity of antibodies were compared with that of antibodies against prostatic acid phosphatase (PAP), prostate-specific antigen (PSA) and gamma-seminoprotein (γ-Sm). (Results) A monoclonal antibody termed KP-9 was obtained and it only reacted with PC-3 and prostate tissues, but did not react with other cell lines and normal tissues. Immunohistochemical staining of prostate tissue revealed that KP-9 stained grandular epithelium and grandular exudate of normal and malignant prostatic tissues, and especially, strongly stained the apical site of grandular epithelium. Western blotting and gel filtration of seminal plasma suggested that the molecular weight of the KP-9 antigen was more than 300, 000 and was different from PAP, PSA and γ-Sm. (Conclusion) We have developed a monoclonal antibody, KP-9 which specifically reacts with prostatic cancer as well as benign prostatic tissues. The antigen recognized by KP-9 appeared to be a new prostate-organ specific antigen and may be a useful marker for prostatic cancer such as PAP, PSA and γ-Sm.
We encountered a patient with megaureter-megacystis syndrome showing a giant bladder and dilated ureters with marked reflux, which is very rare; to our knowledge, only 2 patients have been reported in Japan. The patient was a 4-year-old boy, who showed inborn polyposia and polyuria, and proteinuria at the age of 1 year. He visited the pediatric department in our hospital complaining of cold-like symptoms, stomachache and diarrhea. Urinary infection and kidney dysfunction were observed, and the patient was hospitalized for close examination. Bilateral pyelocaliceal hydronephrosis was detected by ultrasonography, and the patient was referred to our department. CT revealed bilateral hydronephrosis (right atrophic kidney), hydroureters and megacystis. Bilateral grade V vesicoureteral reflux, an increase in the bladder volume (>300ml), and urination without residual urine were noted by voiding cystourethrography. Uroflowmetry revealed that maximum flow rate was 21.6ml/sec, voided volume was 110ml, and residual volume was 24ml. From these examinations, the patient was diagnosed as having megaureter-megacystis syndrome, and underwent antireflux operation of the bilateral ureters using Cohen's procedures.
A 47-year-old woman was admitted when a mass in the urinary bladder was pointed out on ultrasound follow-up after hysterectomy for uterine myoma. Cystoscopy, ultrasonography, CT scan and MRI suggested a tumor in the muscle layers of the urinary bladder. Since the possibility of malignancy could not be ruled out, partial cystectomy was performed. The tumor was diagnosed as endosalpingiosis, a subclassification of mullerianosis histologically. The concept of endosalpingiosis has appeared recently and only 3 cases have been reported none of who had severe symptoms. Our case is the forth in the world. One of these cases had been treated with hormonal therapy as endometriosis, with no effect. Therefore, surgery is recommended as the first treatment of choice.