[Spina bifida accompanied with neurogenic bladder in a patient who lived to be 81 years old].

Spina bifida accompanied with neurogenic bladder in a woman who lived to be 81 years old was reported. Owing to spina bifida (paralyzed below L4), she suffered from urinary incontinence and gait disturbance. Since childhood, she had voided by Credé's maneuver and used a diaper for urinary incontinence. At the age of 56 years old, cystostomy operation was performed for incontinence. After that, she was free from incontinence. The main reason for her longevity was supposed to be the fact that she could accept good medical care and warm family support. Finally she died of lower abdominal carcinoma.

[70% glucose solution: clinical usefulness for postoperative management of anuric patients].

Hemodialysis is necessary for postoperative management of the patients with bilateral renal tumor or chronic renal failure, but taking into account the heavy burden imposed upon the patients, use of postoperative hemodialysis should be kept to the minimum. As one bottle (300 ml) of 70% glucose solution contains 840 cal, two bottles per day (its volume is nearly equal to intensive perspiration) is enough in calorific value. This 70% glucose solution was found useful for the management of patients with acute renal failure. Because the postoperative state of anuric patients is similar to the state of acute renal failure, this time we studied the clinical usefulness of a 70% glucose solution for the postoperative management of these patients. We administered 600 ml of a 70% glucose solution to three postoperative patients, who were operated on for bilateral renal tumor, bilateral renal pelvic tumor, and renal tumor with lung metastasis and who had been on chronic hemodialysis. The rate of blood urea nitrogen increase was very low, and hyperkalemia was not seen. We concluded that a 70% glucose solution was useful to delay the start of hemodialysis and to lessen its frequency, which suggests that it is useful to improve the postoperative course of anuric patients.

[Thrombosis of the posterior scrotal vein: report of two cases].

A 47-year-old architect and a 30-year-old designer of audio goods presented with thrombosis of left and right posterior scrotal vein, respectively. Both had scrotal masses associated with a feeling of heaviness. Physical, operative and microscopic findings were similar. The lesions were palpated as nontender, slender, elastic masses and located parallel to the urethra in the posterior aspect of the scrotum. At surgical exploration the lesions appeared to be thrombosis of posterior scrotal vein and were removed. Both patients have remained well one year in one and four months in the other after operation. Pathological diagnosis for both surgical specimens was organized thrombosis of vein with eosinophilic infiltration. Eosinophilic infiltration to lesions in the present cases and the occupation of patients suggested that some immunological disorders and localized venous stasis for long time during their sitting work might relate to the formation of thrombosis in the posterior scrotal vein. To our knowledge this is the first report of thrombosis of the posterior scrotal vein.

[Clinical features of stage D prostatic carcinoma].

Sixty seven cases of stage D prostatic carcinoma were analyzed according to age, chief complaints, histopathological types, metastatic sites, and serum acid and alkaline phosphatase levels. In spite of metastasis, which were in 62 cases (92.5%) to bone, in 17 cases (25.4%) to lymph nodes, and in 3 cases (4.5%) to the lung, the most common chief complaints were symptoms related to the primary lesion, such as dysuria and urinary frequency. There was no significant correlation between the incidence of bone metastasis and histopathological type. However, higher incidence of lymph node metastasis was observed in the histological types of moderate and poorly differentiated adenocarcinoma than well differentiated type. When cases were divided into two groups by age, significant differences were observed between younger (64 less than or equal to years old) and older (greater than or equal to 65 years old) groups in the following points: 1) Histopathologically, well differentiated type was not recognized in the younger group, while three histological types of well, moderate and poorly differentiated adenocarcinoma, were equally distributed among the older one. 2) Although there was no significant difference in the incidence or the numbers of metastatic sites to bone between the two groups, the younger patients had less symptoms related to bone metastasis. The prominent symptoms in the younger group were complaints about voiding.

[Clinical assessments on pre-treatment prognostic factors in 138 patients with advanced prostatic carcinoma (stage D2)].

We investigated the prognostic factors in 138 patients with stage D2 prostatic cancer by univariate and multivariate analyses. Analysis was restricted to 8 pre-treatment parameters, that is, age, general condition (PS), pain, number of metastases on bone scan, acid phosphatase value, Gleason's primary pattern, secondary pattern, and nucleoli grading. In addition, 4 therapeutic modalities except routine endocrine therapy, that is, castration, oral administration of estramustine phosphate, of 5-fluorouracil (5-FU) or its analogue, and combination chemotherapy, during the whole treatment period were included in the analysis. Univariate analysis (Kaplan-Meier method) showed only PS to be a significant prognostic factor. Multivariate analysis (Cox's proportional hazard model) revealed that PS, Gleason's primary pattern, oral administration of 5-FU or its analogue and combination chemotherapy were significant prognostic factors. However, patients treated by combination chemotherapy had poorer prognosis and chi 2 values of combination chemotherapy was the highest among the four parameters cited above. These results suggested that the 8 pre-treatment parameters examined in this study were not sufficient for predicting the prognosis of each patient.

Prophylactic effects of perioperatively administered neocarzinostatin in renal cell carcinoma.

Eighteen patients with stages I to III renal cell carcinoma were treated with Neocarzinostatin before, during and after nephrectomy. The mean cumulative dose of Neocarzinostatin was 18.0 mg. With a minimum follow-up period of 57 months (4.8 years), two of 18 patients developed metastasis and both were dead. Of 17 control patients who were observed for 72 months (6.0 years) or more, ten had recurrent disease and eight of them were dead. The 5-year survival rates were 94% for patients who received Neocarzinostatin and 62% for control patients. There was a statistical difference in survival between these two groups. Neocarzinostatin seems to be effective in the prevention of postoperative recurrence of renal cell carcinoma.

Intravesical mitomycin C and doxorubicin sequential therapy for carcinoma in situ of the bladder: a longer followup result.

A total of 43 patients with carcinoma in situ of the bladder (primary in 26 and secondary in 17) who underwent intravesical mitomycin C and doxorubicin sequential therapy for 2 multicenter studies were followed for a median period of 45 months (range 10 to 84). Of the patients 32 (74%) achieved complete response after induction therapy and underwent maintenance therapy with either mitomycin C plus doxorubicin, mitomycin C alone or observation only. Of the complete responders 13 (41%) had a local recurrence, and subsequent repeat intravesical mitomycin C and doxorubicin sequential therapy as well as bacillus Calmette-Guerin was effective in a significant proportion (75% or greater). The maintenance therapy did not have a favorable effect on the recurrence rate. In 8 patients (19%) (3 of 32 complete responders and 5 of 11 nonresponders) progression developed, including invasive cancers in 4, metastatic disease in 2 and both conditions in 2. Initial complete responders had a significantly higher progression-free rate than initial nonresponders, although there was no difference in the sites of progression between them. At the last followup 35 patients (81%) remained free of disease with 31 (72%) having a normally functioning bladder. According to these results, intravesical mitomycin C and doxorubicin sequential therapy appears to be applicable as initial treatment for carcinoma in situ of the bladder.

In vivo staining test with methylene blue for bladder cancer.

An in vivo staining test with 0.2 per cent methylene blue was applied to 129 patients with bladder tumor and 16 patients with chronic cystitis within a 6-year interval. Although normal mucosa did not pick up the stain nonpapillary in situ and microinvasive carcinomas did so frequently. Moderate dysplasia was stained in about half of the patients. The intensity of the stain in papillary tumors was correlated with the histologic anaplasia (grade). Grade 1 tumors were stained poorly or unstained in 86 per cent of the tests, whereas grades 2 and 3 tumors picked up the stain in 74 and 96 per cent of the tests, respectively. Even a tiny tumor, if poorly differentiated, was identified easily by the blue stain. The histologic anaplasia of tumors could be assessed roughly according to the intensity of the stain. However, chronic cystitis occasionally took up the stain, especially in cases of marked inflammatory infiltrate a deep stain was recognized. To differentiate nonpapillary early cancer from chronic cystitis the addition of a cytologic examination may be necessary.

[Primary multiple malignant tumors associated with bladder cancer].

Of 487 patients with urothelial bladder cancer seen during the past 22 years, 37 (7.6%) had other primary malignant tumors. In recent years the number of patients with double cancer markedly increased. The male/female ratio was 2.7:1 and the mean age at the time of diagnosis of the second primary cancer was 70 (56-84) years. Of the other organ cancers, 18 (47%) were in the digestive tract and 7 (18%) in the respiratory tract. Six patients had lesions that were diagnosed simultaneously and 31 had lesions that were diagnosed at intervals. The interval in 31 patients with metachronous double cancer ranged from 1 year and 1 month to 40 years; the mean interval was 9 years and 7 months.

Intravesical combination chemotherapy with mitomycin C and doxorubicin for carcinoma in situ of the bladder.

We treated 30 patients with carcinoma in situ of the bladder via intravesical combination chemotherapy. As an induction therapy 20 mg. mitomycin C on day 1 and 40 mg. doxorubicin on day 2 were instilled into the bladder once a week for 5 consecutive weeks. Patients who achieved complete response were assigned a maintenance instillation of mitomycin C alone every 2 to 4 weeks for 1 year. A total of 19 patients achieved complete response following an initial course of induction therapy and 2 partial responders to initial therapy also achieved complete response after repeated induction therapy, resulting in a 70 per cent over-all complete response rate. Toxicity was considerable with moderate to severe bladder irritation occurring in 20 patients but it was tolerable in the majority. Of 21 complete responses 13 remained free of disease for 6 to 43 months (average of 23 months), 5 had recurrent carcinoma in situ and 1 had invasive urethral cancer. In contrast, of 9 nonresponders 2 and 1 had invasive cancer of the bladder and ureter, respectively.