(Objective) Pressure-flow study (PFS) is an excellent method for detecting the bladder outlet obstruction. However, PFS with the transurethral catheter has the disadvantage of unphysiological urination during testing. In the present study, we compared the urination in PFS with that in uroflowmetry (UFM) and analyzed the effect of the transurethral catheter. (Materials and Methods) The subjects were 43 men who underwent PFS at Yamato Takada Municipal Hospital. PFS and UFM were compared with respect to four parameters, i. e., Qmax, the residual urine volume, the region on Liverpool nomogram, and the flow curve pattern (Jørgensen's classification). (Results) For PFS using a transurethral catheter, (1) Qmax was decreased by a mean of 2.6ml/s and the residual urine volume was increased by a mean of 26.3ml compared with UFM, and (2) the Liverpool nomogram and the flow curve pattern showed more impairment of urination with PFS than UFM. (Conclusion) It is suggested that PFS using a transurethral catheter may not reflect physiolosical urination.
(Purpose) Brachytherapy as an option for the treatment of prostate cancer has been commonly performed in USA. As the permanent seeding of the radioactive materials is strictly restricted by the law in Japan, brachytherapy must be performed by the temporary implant. This treatment has been performed at a few facilities in Japan mostly using high dose-rate iridium. Only our facility has been using low dose-rate iridium (LDR-Ir) for prostate cancer. This study evaluates the clinical results of the treatment. (Patients and Methods) Since December 1997 to December 1999, 26 patients with histologically diagnosed as prostate cancer (Stage B, 92%; Stage C, 8%) underwent brachytherapy. Twenty-two patients received brachytherapy alone, three were treated with a combination of brachytherapy and external beam radiotherapy (ERT) and one was treated with a combination of brachytherapy and neoadj uvant endocrine therapy. Patients ranged in age from 61 to 84 (median 76) years old. Treatment was initiated with perineal needle placement. From 10 to 14 needles were placed through the holes on the template which was fixed to the stabilizer of the transrectal ultrasound probe. After the needle placement, CT scan was performed to draw distribution curves for the treatment planning. LDR-Ir wires were introduced to the sheath and indwelled during the time calculated from dosimetry. Peripheral dose was 70Gy for the monotherapy of brachytherapy. For the combination therapy, 40Gy was given by brachytherapy and 36Gy with ERT afterwards. LDR-Ir wires were removed after completion of the radiation and patients were followed with serum PSA level and annual biopsy. (Results) During 2 to 26 (median 12) months follow-up, 8 out of 9 patients with initial PSA level above 20ng/ml showed PSA failure. All 13 patients with initial PSA level lower than 20ng/ml were free from PSA failure. Eight out of 11 patients with Gleason's score 7 or higher showed PSA failure, and all 14 patients (including three patients with combined therapy) with Gleason's score 6 or less were free from PSA failure. Annual biopsy was performed in 8 patients, and 4 patients histologically revealed tumor free and 4 patients (two of them showed PSA failure) were tumor positive. No major complication was observed, however, some minor side-effect as irritability was seen in 65% of the patients. (Conclusions) The results showed that brachytherapy with LDR-Ir was an acceptable treatment as long as the patients were selected strictly with PSA level and Gleason's score. A good candidate for this treatment is the patient whose PSA level is lower than 20ng/ml and Gleason's score is 6 or less. The treatment is effective and safe, but further observation is necessary to reach the conclusion.
(Purpose) To describe the outcome of chemotherapy using cisplatin-based regimen, and experimental combination with carboplatin and ifosfamide to treat advanced seminoma. (Methods) From 1981 to Jan. 1999, 15 patients with Stage IIA, IIB, IIIA or IIIC metastatic seminoma and one patient with lung disease, who suffered a relapse of his primary mediastinal lesion were treated. Three of these patients had relapsed, following surveillance for Stage I testicular cancer, and another had received prophylactic radiotherapy to the retroperitoneal lymph nodes in advance. The first patient's regimen consisted of cisplatin and cyclophosphamide. Since 1983, cases have been treated with the same regimen as that used to treat non-seminomatous germ-cell tumors; cisplatin/vinblastine/bleomycin (PVB); cisplatin/vinblastine/actinomycin D/cyclophosphamide/bleomycin (VAB-6); cisplatin/etoposide/bleomycin (BEP). From 1993, six patients with non-bulky metastatic seminoma participated in a trial involving 3 courses of carboplatin (400mg/m2) and ifosfamide (2, 000mg/m2, 3 days). (Results) Of the entire group, 10 patients (62.5%) achieved a CR after chemotherapy alone. Four cases who received radiation, following chemotherapy, produced CR. Surgical resection of residual tumors were performed on 2 patients. Resected tumors were fibrous and no evidence of malignancy. All those individuals who participated in this study, are alive and disease-free today, from 11 months to 18 years. Carboplatin and ifosfamide demonstrated only mild toxicity, during a 4-week cycle, with subjects being treated on an outpatient basis. (Conclusion) As expected, the type of chemotherapy we used, to treat non-seminomatous germcell tumors proved to be highly effective for seminomatous types, as well. Carboplatin and ifosfamide performed well and safe, in the treatment of non-bulky metastatic seminoma. Comparative studies of long-term treatment results and QOL, using either radiotherapy or low-toxicity chemotherapy for Stage IIA disease should be undertaken.
(purpose) Testicular microlithiasis (TM) is a relatively rare condition characterized by calcific concretion within the seminiferous tubules. Little has been reported on the incidence or the clinical implication of TM among Japanese. To address the problem, we evaluated pathologic specimens from biopsies and orchiectomies, of testes with various conditions. (Materials and Methods) Pathologic specimens of the testes of 200 cases, 56 from orchiectomy and 144 from testicular biopsy, were investigated. (Results) The pathological diagnosis of TM was confirmed in seven (3.5%) cases, four of which were associated with germ cell tumors and the other three were obtained from testicular biopsies performed for examination of infertile men. Of the 41 patients with germ cell tumors, four (9.8%) were found to have TM, and another three (2.5%) were identified among 122 patients with infertility. The prevalence of TM is significantly higher in specimen with germ cell tumors than those without germ cell tumors (p<0.05). (Conclusions) Although TM is rarely encountered, this condition is relatively often accompanied by testicular malignancy. Further investigation would be fundamental to ascertain the relationship between TM and testicular malignancy.
A case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 94-year-old woman with a progressive, grade 3 undifferentiated carcinoma, showed marked leukocytosis (maximum 29, 780/mm3) with an elevated G-CSF (420pg/ml). Immunohistochemical examination with monoclonal antibody specific for G-CSF revealed positive staining. Further examination for epidermal growth factor receptor (EGF-R) and p53 were both positive and Ki67 index were 40.7%. These data suggested that this tumor had extremely aggressive growing nature, as the biological character is this.
We report a case of Churg-Strauss syndrome complaining of gross hematuria. A 74-year-old man was admitted to our hospital for further examination of gross hematuria. Abdominal CT and retrograde pyelography revealed left renal pelvic tumor, and left nephrectomy was performed. There was no tumor, but submucous hemorrhage was seen in the renal pelvis. The histopathologic diagnosis was allergic granulomatous angitis. The administration of predonisolone was done, but he suddenly died of acute heart failure after 1 month postoperatively.
Secondary leukemia following chemotherapy or radiotherapy for mediastinal germ cell tumors in a well-described entity. It also may occur in patients with testicular germ cell tumors. We report a case of secondary leukemia occurring in a 31-year-old man who received ultra high-dose chemotherapy with peripheral blood stem cell autotransplantation (PBSCT) for a refractory testicular cancer (pathology; Seminoma, Embryonal carcinoma, Yolk sac tumor, Choriocarcinoma) with IIIB2 under Japanese classification, poor-risk group under Indiana classification. The initial levels of serum LDH, AFP and β-HCG were high at 959IU/l, 1, 452ng/ml and 800ng/ml. He received total 11 cycles of systemic chemotherapy (2 cycles of PVB regimen, 4 cycles of PEB regimen, 3 cycles of VIP rigimen and 2 cycles of ultra high-dose chemotherapy with PBSCT for pulmonary and para-aortic lymphnode metantasis following his initial orchiectomy. The total amount of etoposide (VP-16), cisplatin (CDDP), carboplatin (CBDCA) and ifosfamide (IFM), this patient received was 7, 225mg/m2, 1, 510mg/m2 1, 750mg/m2, and 50.5g. He has survived with CR of disease. Severe and persistent pancytopenia developed 25 months after his initial orchiectomy. Bone marrow examination showed AML (M2 with eosinophilia) under French-America-British (FAB) classification. Therefore, he was diagnosed as secondary leukemia following high-dose chemotherapy. He received total 6 cycles of systematic chemotherapy for the secondary leukemia in the internal department. He is planing to have bone marrow transplantation. To our knowledge, this is the first reported case in the literature relevant to secondary leukemia following ultra high-dose chemotherapy with PBSCT in testicular tumor in Japan.