[Treatment and prognosis of T 4 renal cell carcinoma].

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, lymph node 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 appropriate candidates for extended nephrectomy.

[Clinicopathological study on patients with renal cell carcinoma according to whole area histological sections].

BACKGROUND: We tried to establish new classification of histological grade and indication of elective nephron-sparing surgery (ENSS) in renal cell carcinoma (RCC), and studied histological changes according to tumor size. METHODS: We made whole area histological sections on 142 cases with RCC and investigated histological aspects and prognosis. RESULTS: (1) To classify the grade of the cases, the worst grade which occupied more than 10% of the tumor provided most appropriate prognosis. (2) In 144 cases (kidneys), satellite tumor lesions (STL) were observed in 69 cases (47.9%), and the cases with vein invasion were observed in 75 cases (51.4%). Incidence of these two factors increased with tumor size. (3) From the point of view of location of STL and vein invasion, ENSS was possible with taking more than 2 cm surgical margin in the cases with less than 4 cm in size and slow growing type. But indication of ENSS should not be decided with ease. (4) Incidence of the cases with multiple structural and cell types and grades increased with tumor size. (5) Incidence of the cases with solid structure, spindle or pleomorphic cell type and high grade increased with tumor size. (6) It was supposed that tumor heterogeneity and progression could be associated with tumor growth in each cases. CONCLUSION: These results suggest the necessity of treatment of the cases with RCC as small as possible. If the tumor is less than 4 cm, prognosis tends to be good, and ENSS might be possible in some cases.

[Prognosis in the cases with renal cell carcinoma according to clinical parameters].

BACKGROUND: The objects of this study is to evaluate the clinical prognostic factors in renal cell carcinoma. MATERIALS AND METHODS: During a 30-year period from January 1965 to December 1994, 1301 cases with renal cell carcinoma were treated at the Yokohama City University Hospital and its affiliated hospitals. In these cases, cause specific 679 cases from January 1965 to December 1990 were analyzed in a study undertaken to investigate long-term treatment results and clinical prognostic factors. RESULTS: 1. The cause specific 5-, 10-, 15-, and 20-year survival rates were 48.7%, 41.1%, 32.3%, and 26.5% respectively, indicating thus that a great number of cases had an ominous prognosis even 5 years or moreafter surgical treatment. 2. Among patients under 40 years of age (n = 29) none died more than 2 years after receiving operation, the prognosis for this particular group of cases being relatively good. 3. Female, incidentally detected cancer, small tumor size (< or = 4.0 cm), slow growing type and low stage were proven to be favourable prognostic factors in renal cell carcinoma. 4. The cause specific 5-year survival rate for the patients (n = 239) from 1965 to 1981 was 33.8%, while the rate for the patients (n = 440) from 1982 to 1990 was 56.5%. This improvement of survival rate was brought by the increase of the incidentally detected renal cell carcinoma. 5. In the incidentally detected renal cell carcinoma, the incidence of slow growing cases and the cases of less than 4.0 cm tumor size were higher than in the symptomatic renal cell carcinoma. 6. Multivariate analysis using Cox's proportional hazard model showed that stage was the most important prognostic factor. CONCLUSIONS: These results suggested that sex, age, symptom, tumor size, growing type, and stage were important prognostic factors in renal cell carcinoma.

Characterization of the MexC-MexD-OprJ multidrug efflux system in DeltamexA-mexB-oprM mutants of Pseudomonas aeruginosa.

Expression of the multidrug efflux system MexC-MexD-OprJ in nfxB mutants of Pseudomonas aeruginosa contributes to resistance to fluoroquinolones and the "fourth-generation" cephems (cefpirome and cefozopran), but not to most beta-lactams, including the ordinary cephems (ceftazidime and cefoperazone). nfxB mutants also express a second multidrug efflux system, MexA-MexB-OprM, due to incomplete transcriptional repression of this operon by the mexR gene product. To characterize the contribution of the MexC-MexD-OprJ system to drug resistance in P. aeruginosa, a site-specific deletion method was employed to remove the mexA-mexB-oprM region from the chromosome of wild-type and nfxB strains of P. aeruginosa. Characterization of mutants lacking the mexA-mexB-oprM region clearly indicated that the MexC-MexD-OprJ efflux system is involved in resistance to the ordinary cephems as well as fluoroquinolones and the fourth-generation cephems but not to carbenicillin and aztreonam. Rabbit polyclonal antisera and murine monoclonal antibody against the components of the MexA-MexB-OprM system were prepared and used to demonstrate the reduced production of this efflux system in the nfxB mutants. Consistent with this, transcription of the mexA-mexB-oprM operon decreased in an nfxB mutant. This reduction appears to explain the hypersusceptibility of the nfxB mutant to beta-lactams, including ordinary cephems.

Birth rate and mortality rate of infants with congenital malformations of the limbs in the Awajishima free-ranging group of Japanese monkeys (Macaca fuscata).

The birth rate and mortality rate of infants with congenital malformations of the limbs were examined in the Awajishima free-ranging group of Japanese macaques (Macaca fuscata). Of the 606 infants born between 1978 and 1995, 86 (14.2%) were malformed. The male-female ratio did not differ between malformed and normal infants. Most kin-groups included females who gave birth to malformed infants at least once. The mortality rate within the first year after birth for malformed infants (28.2%) was significantly higher than that for normal infants (10.0%). However, this indicates that more than 70% of malformed infants were able to survive for the first year of life, even though they were unable to cling to their mother's ventrum due to their limb deformities. This finding indicates that maternal care-taking is sufficient to enable malformed infants to survive during the early stages of development and that clinging by the infant is not necessary for the display of maternal care.

[Prognostic factors for metastatic renal cell cancer].

We examined various prognostic factors of metastatic renal cell carcinoma. Patients who had metastasis at nephrectomy (A group, 38 cases) and those who had metastasis as recurrent tumors after nephrectomy (B group, 38 cases) entered in this study. Five-year survival rate of total cases after confirmation of metastatic foci was 15% and there was no statistical significant difference between A and B groups. Several pathological factors were related to poorer prognosis and included large diameters of original tumors, positive lymph nodes, higher grade tumors and non-clear cell type tumors. Patients who have a solitary lung metastasis showed better prognosis compared to those with multiple lung metastases or metastases of other organs. Two factors related to treatment were shown to contribute to better prognosis. These were the response to interferon alfa (IFN alpha) and the possibility of total resection of visible metastatic tumors. Patients who belong to A group were shown to achieve markedly better therapeutic benefit from IFN alpha or IFN alpha plus anticancer drugs. Five-year survival rate for the responders was 40%, as compared to less than 5% for the non-responders. Ten-year survival rate for patients with metastasis who had undergone complete resection of visible tumor was 50%, and the for patients belonging to B group Showed 80%. We concluded that these prognostic factors should be considered to decide how to select patients with metastatic renal cell cancer.

Histological evaluation of benign prostatic hyperplasia treated by long-term administration of chlormadinone acetate (CMA).

Although the clinical effects of attempted nonsurgical treatment of benign prostatic hyperplasia have been well documented, detailed histological evaluation of the effects of treatment appears to be limited. The effect of long-term administration of an antiandrogen, chlormadinone acetate (CMA), on benign prostatic hyperplasia was evaluated with histological comparison of two biopsy specimens, one before treatment and one after treatment. Secretory epithelium showed obvious regressive changes with occasional basal cell prominence after CMA treatment. Stromal elements, however, did not show any marked changes, except for occasional edematous loosening. Scores of multiple epithelial parameters tended to be correlated with clinical improvement in urinary obstructive symptoms, especially in patients with predominant glandular hyperplasia. These results suggest that long-term administration of the potent antiandrogen CMA to inhibit dihydrotestosterone-receptor binding might be a useful therapeutic maneuver in patients with glandular hyperplasia, without any deterioration of the stromal component.

[Study of satellite tumor nodules in renal cell carcinoma].

Topography and histological types of main tumor and satellite tumor nodules (STN) were investigated on 60 cases of renal cell carcinoma by gross and microscopic study by making whole area histological sections. 30-100 histological slides were made from the median sagittal section and multiple horizontal sections of renal cell carcinoma. STN were observed in 28 cases of the 60 cases (46.7%) and could be classified into 3 types according to their location relative to the main tumor. STN could not be observed in some cases despite the large main tumor of 10 cm or more, while STN were observed in some cases with the main tumor of only 2.5 cm or less. High grade and high stage cases showed a high incidence of STN. It is considered that, only in cases, with the tumors of low grade, low stage and has only 1 STN or less, conservative surgery on renal parenchyma is possible. When the case is of low grade and low stage and has a possibility of preserving normal renal parenchyma, conservative surgery on renal parenchyma may be justified even if the tumor is large.

[Results of pulmonary resection for metastatic renal cell carcinoma].

Nine cases of metastatic renal cell carcinoma to the lung were studied to assess the efficacy of surgical management. Between January, 1965 and December 1981, 116 cases of metastatic renal cell carcinoma to the lung were treated. Nine of these cases (7.8%), were treated with surgical resection for the pulmonary metastases. The overall crude survival rate after pulmonary resection was 33.3% (3/9) at 3 years and 22.2% (2/9) at 5 years. Two patients are long-term survivors, one still being in good health 108 months, and the other 72 months after pulmonary resection. Pulmonary resection for metastatic renal cell carcinoma was considered effective in some selected slow-growing cases as protection against metastasis from a metastasis.

Needle tract seeding following puncture of retroperitoneal liposarcoma.

9 case of needle tract seeding following percutaneous puncture of an avascular mass, which proved to be a retroperitoneal liposarcoma, is presented.