(Background and purpose) Depression is well known as one of the psychiatric complications of interferon (IFN) therapy in patients with chronic active hepatitis C. We compared the psychiatric status during interferon therapy between patients with renal cell cancer (RCC) and those with chronic active hepatitis C. (Methods) The psychiatric status of 40 patients with renal cell cancer, 36 who were subjected to radical nephrectomy and 4 who were not because of the presence of distant metastasis and other complicated underlying diseases, was assessed by psychiatrists before and at 2, 4, 12 and 24 weeks after the start of IFN therapy according to the major depressive episode diagnostic criteria listed in the DSM-III-R and the Hamilton Depression Scale (HDS). The mental aspect was measured using the Eysenk Personality Questionnaire (EPQ) before IFN therapy, and the results were compared with those obtained in 85 hepatitis C patients evaluated according to the same protocol for psychiatric assessment. (Results) Eight of the 40 patients were diagnosed as having depression before IFN therapy and 5 of them became even more depressed 2 weeks after the start of IFN therapy. Nine patients were found to be depressed after the start of IFN therapy, 7 of them were diagnosed before 4 weeks of therapy. All the patients needed treatment for depression: discontinuation of IFN therapy in 4, decrement of the IFN dose in 8, and psychiatric drug medication in 13. The patients who suffered from depression had significantly higher scores in neuroticism (EPQ) before IFN therapy than those who did not become depressed. There was no difference in age, sex or cancer stage between the two groups. The occurrence of depression in RCC patients was the same as that observed in hepatitis C patients receiving IFN therapy. But in RCC patients the depressive state was diagnosed earlier and was more severe than that observed in hepatitis C patients. (Conclusion) Urologists should be aware of the psychiatric symptoms of RCC patients under IFN therapy just as in hepatitis patients. The depression in RCC patients was considered to be related to the cancerous disease itself which may explain its higher degree of severity, as compared to hepatitis C patients.
(Purpose) We reviewed cases of intrascrotal tumors treated at our institution except for germ cell testicular tumors. (Patients and Methods) From 1977 to 1998 (22 years), 120 cases of intrascrotal tumors treated at the University of Tsukuba. Of these, 15 cases (12.5%) were not germ cell testicular tumors. The patients' ages varied between 2 and 77 years with a mean of 49.6. (Results) The most common complaint regarding symptoms was painless testicular enlargement. Tumor weight ranged from 2 to 200g, with an average of 104.6g. The histological diagnoses of 15 patients were 8 malignant lymphomas, 2 paratesticular rhabdomyosarcomas, 2 metastatic tumors (origin; stomach and prostate), 1 epidermoid cyst, 1 cyst of tunica testis, and 1 adenomatoid tumor. As for the cases with malignant lymphoma, all of them were non-Hodgkin's lymphoma whose clinical stages were stage I in 2 cases and stage IV in 6 cases. Five 8 patients died in spite of systemic chemotherapy after an orchiectomy, whereas 2 cases with metastatic tumors died of primary cancer, and two cases with paratesticular rhabdomyosarcoma are still alive and have had no evidence of disease. (Conclusions) Intrascrotal tumors except for germ cell testicular tumors are not common, and consist of various diseases. In particular, some kinds of malignant lymphoma mimic anaplastic seminoma histopathologically. Therefore, accurate diagnosis and precise treatment is important in the patient with intrascrotal tumors.
(Background) Sigmoid neobladder (Reddy method) is one of the representative neobladder after radical cystectomy. Occasionally we experienced difficulty on urethral anastomosis in sigmoid neobladder. Here we investigated preoperative X-ray of air-contrast barium enema and clarified what type could be easily anastomosed in sigmoid neobladder. (Material and Methods) We performed five cases of total cystectomy with sigmoid neobladder replacement. Of the five, we can easily make a urethral anastomsis in three cases but not easily in other two cases. We investigated sigmoid colon length, it's internal diameter, it's form and it's mobility that was substituted for elevation level of rectosigmoid using preoperative X-ray of air-contrast barium enema. We also studied seventy five cases of X-ray of air-contrast barium enema who visited our hospital with various complaints such as lower abdominal pain. (Results) The length of three cases with easily anastomosed were 45.7cm in diameter other two cases 33.5cm in diameter. (over all 47.5cm) The internal diameter were 49mm and 33.5mm respectively. (over all 44.4mm) It was considered that Reddy method was indicated who had at least averaged sigmoid colon length and internal size. Sigmoid colon form were classified into 3 groups (type N, type l and others). There were no difference on colon length regarding sigmoid form, but others was considered to be improper form because significant difference was observed between type N and others in internal diameter. Three cases with easily anastomosed demonstrated a positive correlation of the elevation of the sigmoid colon over promontorium in the air contrast barium enema, other two cases negative. The elevation cases of the sigmoid colon in X-ray of air contrast barium enema had long sigmoid colon than other types. (p<0.0001) Tha mean length of them was 51.6cm in diameter. (conclusion) Sigmoid neobladder was at least indicated in men who had averaged sigmoid colon length. The sigmoid colon elevation sign in X-ray of air contrast barium enema did not require the measurement of sigmoid colon length and that sign implied good indication for sigmoid neobladder.
(Purpose) In order to define the clinical significance of serum soluble Interferon α/β receptor (sIFN α/βR) levels, we determined sIFN α/βR concentrations in serum of patients with urological benign and malignant diseases. (Materials and Methods) Serum sIFN α/βR levels were measured in normal control (n=2), patients with benign diseases (n=50) included urolithiasis (n=16), prostatic hypertrophy (n=13), and malignant diseases included bladder cancer (n=49), renal cell carcinoma (n=30) and prostate cancer (n=36) by the enzyme linked immunosolbent assay (ELISA) using monoclonal and polyclonal antibodies. The levels of serum sIFN α/βR was correlated with the results of other hematoserological examinations, and clinical or pathological characters of each urological malignancies. (Results) The serum sIFN α/βR levels (pg/ml) of patients with urolithiasis (2, 370.6±640.6, p=0.0002), benign prostatic hypertrophy (2, 121.1±550.6, p=0.0103), bladder cancer (2, 512.3±1, 012.3, p=0.0006), renal cell carcinoma (2, 686.4±1, 510.9, p=0.0046), prostate cancer (3, 188.7±1, 788., p=0.0003) showed significantly higher values than those of controls (1, 709.5±346.7). Moreover, we found statistically significant correlations among serum creatinine (Cr) levels and sIFN α/βR levels. However, there were no correlations between the sIFN α/βR levels and clinical stage, or histological grade in the patients with bladder cancer or prostate cancer, whenever the levels of sIFN α/βR were corrected by serum Cr levels. On the other hand, high level of corrected serum sIFN α/βR was observed in patients with high stage or high grade renal cell carcinoma, but not significant statistically. (Conclusions) Elevated serum sIFN α/βR was observed in patients with urological disease. Further examinations should be necessary to determine the clinical usefulness of serum sIFN α/βR.
A patient was 31-year-old man with the chief complaint of 38°C fever. He was pointed out left renal tumor by abdominal ultrasonography and computerized tomography (CT). CT revealed left infraclavicular, mediastinal and retroperitoneal lymph nodes swelling and left renal tumor. Serum α-fetoprotein (AFP) and β-human chorionic gonadotropin (HCG-β) level were elevated. The diagnosis of extragonadal germ cell tumor and left renal cell carcinoma was comfirmed pathologically by infraclavicular lymph node and renal biopsy. He was treated with 4 courses of BEP regimen and interferon-α, cimetidine therapy for 2 weeks preoperativelly. After serum tumor markers were normal level, he underwent left radical nephrectomy and left infraclavicular, mediastinal and retroperitoneal lymph node dissection. The histology of all lymph nodes was necrotic tissue, but operation was imcompleted. Therefore VIP therapy was performed postoperativelly. This is the first case of extragonadal germ cell tumor coexsisted with renal cell carcinoma in the world.
A 59-year-old man with spinal arteriovenous malformation at L-1 level was referred to our clinic for urinary retardation and urinary protraction. Bulbocavernosus reflex (BCR) was performed at empty bladder and at the storage phase during cystometry. BCR was evoked by compressing the glans penis. The evoked reflexes were examined by palpating the contractile responses of the bulbocavernosus muscle and bipolar surface electrodes on each side of para-perineal raphe. Evoked response of BCR couldn't be detected at empty bladder, but obvious responses of BCR were detected at about 300ml bladder filled. For further evaluation, a concentric needle electrode was inserted into the periurethral striated muscle to examine the evoked potential of BCR. The responses were unstable at empty bladder, but stable evoked potentials were obtained at storage phase. BCR performed only at empty bladder may cause false negative result.
Two cases of carcinoma developed in vesical diverticulum were encountered. Both these males, the first, 66-year-old and the second case, 68-year-old gentlemen, visited our clinic with a complaint of asymptomatic gross hematuria. Total cystectomy was performed, and an ileal neobladder was constructed for total bladder replacement in both two cases. Pathological examination of the first case revealed transitional cell carcinoma, and the second case showed adenocarcinoma mixed with transitional cell carcinoma. Although primary carcinoma developed in vesical diverticulum was initially reported by Williams in 1883, adenocarcinoma is very rare. The diagnosis is often challenging and the prognosis is dire. Both our cases were successfully treated with total cystectomy and an ileal neobladder was constructed for total bladder replacement. Careful management and aggressive therapy for such patients may make even cure possible.