Cross-cultural comparison of breast cancer patients' Quality of Life in the Netherlands and Japan.

PURPOSE: Cultural differences are hypothesized to influence patients' Quality of Life (QoL) reports. However, there is a lack of empirical cross-cultural studies comparing QoL of patients with cancer. This study aims to compare QoL of women with breast cancer in the Netherlands and Japan, and to investigate the association of QoL with sociodemographic, clinical, and psychological variables (illness perceptions). METHODS: Dutch (n = 116) and Japanese (n = 148) women with early breast cancer undergoing chemotherapy completed the EORTC QLQ-C30 and Brief Illness Perception Questionnaire immediately before their second cycle of chemotherapy. RESULTS: Dutch women reported poorer Physical, Role, Emotional, and Cognitive functioning than Japanese women. Additionally, illness perceptions were significantly different in Japan and the Netherlands, but these did not vary across treatment type. In Japan, QoL of women receiving AC-chemotherapy was better than that of women receiving FEC-chemotherapy, whereas in the Netherlands, QoL did not vary as a function of chemotherapy. Illness perceptions about symptom severity, adverse consequences, and emotional representations were negatively related to most domains of patients' QoL in both countries. Adding illness perceptions as covariates to the ANOVA analyses rendered the effects of country and treatment type on QoL non-significant. CONCLUSIONS: Comparing Dutch and Japanese women with early breast cancer revealed important differences in treatment modalities and illness perceptions which both appear to influence QoL. Perceptions about cancer have been found to vary across cultures, and our study suggests that these perceptions should be considered when performing cross-cultural studies focusing on patient-reported outcomes.

Evaluation of multidisciplinary treatment of bladder cancer, especially in chemoimmunotherapy (ADM and OK-432) as a consolidation therapy.

The relapse rate of bladder cancer (transitional cell Ca) is said to be about 45%-80% even after tumor resection. Multidisciplinary treatment was designed and studied to prevent such recurrence. This treatment was designed to have three steps: induction, consolidation, and maintenance therapy. Following surgical tumor removal, OK-432 and Adriamycin (ADM) were administered as consolidation therapy, followed by administration of PSK and carboquone (CQ) in small amounts as maintenance therapy continuously for about 3 years, and the course was observed. In both consolidation and maintenance groups various non-specific immunoparameters were superior in groups receiving combined immunotherapeutic agents. Thus, the use of immunotherapeutic agents in combination with chemotherapeutic agents was considered to be effective. The 3-year recurrence rate was only 8% in the multidisciplinary treatment group, while that in the non-multidisciplinary treatment group was 61%. This approach, especially with chemoimmunotherapy (ADM and OK-432) as a consolidation therapeutic mode, is therefore considered to be useful for the prevention of recurrence.

Intraarterial infusion chemotherapy with [Sar1,Ile8]angiotensin II for bladder cancer.

Thirty-three patients with primary bladder cancer (nine stage T1 with multifocal tumors and 24 stage T2-4) were treated with intraarterial infusion chemotherapy including cisplatin, doxorubicin, and [Sar1,Ile8]Angiotensin II(AT II). Of the 32 evaluable patients, 12 had pathologically proven complete response (CR), 19 showed partial response (PR), and one showed no change (NC); the overall response rate (CR + PR) was 97%. The blood pressure increased in response to the administration of [Sar1,Ile8]AT II in all the patients; the mean increase in the systolic blood pressure was 36 mmHg. Most of the side effects were mild to moderate in severity, transient in nature, and included nausea/vomiting (100%), alopecia (84%), leukopenia (66%), headache (9%), nephrotoxicity (6%), diarrhea (3%), skin pigmentation (3%), and neurotoxicity (3%). One patient who dropped out of the study developed hemiplegia as a result of cerebral infarction. The findings indicate that it is necessary to exercise caution in selecting the patients to be subjected to this therapy. We conclude that intraarterial infusion chemotherapy combined with a vasoconstrictor has a significant effect not only against multifocal superficial bladder cancer but also against invasive bladder cancer.

Preferential acetazolamide-induced vasodilation based on vessel size and organ: confirmation of peripheral vasodilation with use of colored microspheres.

When carbonic anhydrase activity decreases, the regional blood flow (rBF) in organs increases as hypercapnia develops. However, the effects of acetazolamide (AZ)-induced vasodilation have not been estimated with respect to vessel size and organs. The aim of this study was to determine the diameter of the capillaries in various organs that respond to inhibition of carbonic anhydrase activity by AZ. White rabbits were anesthetized with urethane and ketamine and infused with AZ. While the systolic blood pressure (SBP), pH, hemoglobin concentration, and base excess did not change, the partial pressure of arterial oxygen (PaO2) increased significantly and the partial pressure of arterial carbon dioxide (PaCO2) decreased significantly with AZ. The rBF was calculated by using 3 different sizes (15, 25, and 50 microm) of colored microspheres (CM). The rBF measured with 15 microm CM in the brain, kidneys, and liver increased in response to AZ, and the rBF in these organs was different with the different sizes of CM. However, the rBF calculated by using the different sizes of CM in the stomach and abdominal muscle did not change after the administration of AZ. The AZ-induced vasodilation occurred in all sizes of vessels in the liver, in the small and medium-sized vessels in kidneys, and in the larger capillaries in the brain.

[Two cases of methicillin-resistant Staphylococcus aureus (MRSA) sepsis following craniotomy].

We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers related to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by 67Ga to be spondylo-diskitis at the level of L2-L3. The lesion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was treated with arbekacin (200 mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symptoms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400 mg/day).

[Estimation of the weddellite to whewellite ratio by infrared spectroscopy].

Powder samples of 56 calcium oxalate stones the contents of weddellite, whewellite and apatite of which had been determined by thermogravimetry (TG) were studied by infrared spectroscopy (IR). When the ratio of the weddellite content to the total of weddellite and whewellite (weddellite ratio) calculated using Oka's method on the infrared spectra was compared with that determined previously by TG, the correlation coefficient between these ratios was 0.734. For the 24 calcium oxalate stones the apatite content of which was less than 10%, the correlation coefficient between these ratios was 0.976, although the weddellite ratio calculated using Oka's method was significantly higher than that determined by TG (P less than 0.01). In an attempt to estimate the weddellite to whewellite ratio by IR regardless of the content of apatite, the ratio of the depth of the absorption band at 780 cm-1 (H780) to the depth of the absorption band at 1,320 cm-1 (H1320) was compared with the ratio of the whewellite content to the total of whewellite and weddellite contents determined by TG. The correlation coefficient between these ratios was 0.953. We conclude that the ratio of H780 to H1320 determined from the infrared spectra obtained from a 0.3 to 1 mg powder sample of calcium oxalate stone is useful in the estimation of the weddellite to whewellite ratio.

[The role of urine pH in the occurrence of phosphaturia].

The density of calcium phosphate and the pH were determined in 15 postprandial urine specimens with heavy precipitation of amorphous calcium phosphate, that is phosphaturia, collected from 5 patients with calcium urolithiasis (stone-formers) and 3 patients with no known urological disease (controls). Phosphaturia, not related to urinary tract infection or administration of alkalinizing agents, was found repeatedly at our outpatient clinic in these patients. The correlative relationship was not confirmed between the density of calcium phosphate and the pH. The concentration of calcium and phosphorus was also determined in 10 urine specimens with phosphaturia. The concentration of phosphorus was correlated significantly with the pH (r = -0.775, p less than 0.01), although the concentration of calcium was not correlated with the pH. The pH of 11 urine specimens with phosphaturia from the controls was 7.51 +/- 0.31 (mean +/- S.D.) and the pH of 18 urine specimens with phosphaturia from the stone-formers was 6.81 +/- 0.34. The pH was significantly lower in the urine specimens from the stone-formers than in those from the controls (p less than 0.01). We have noted that the occurrence of phosphaturia depends not only on the urinary pH but on the concentration of phosphorus. It is interesting that phosphaturia often occurs in urine specimens with a pH below 7 in stone-formers.

[Study of the transformation of weddellite to whewellite in calcium oxalate stones by x-ray diffraction].

A clay film was made of the stone powder and water drops on a slide glass and dried at 100 to 110 degrees C or at room temperature in the horizontal position for 20 calcium oxalate stones which had been received between April, 1978 and August 1980. Each clay film was scanned with an X-ray diffractometer using CuK alpha radiation, stored at room temperature in a wooden sample case and analysed again by X-ray five to seven years after the first X-ray analysis. Then the recent diffractograms of 20 powder samples were compared with the previous ones regarding the peak heights at 14.2 degrees, 14.8 degrees and 25.8 degrees (2 theta), which were considered representative of weddellite, whewellite and apatite contents and designated as Iwe, Iwh and Iap, respectively. Since there was a good correlation between Iwe/Iwe + Iwh + Iap and weddellite/weddellite + whewellite + apatite that was determined by thermogravimetry (Fig. 1), the transformation rate of weddellite to whewellite can be expressed as the change of Iwe/Iwe + Iwh + Iap. One sample Iwe/Iwe + Iwh + Iap of which decreased by 48% in seven years (Fig. 3) and another sample Iwe/Iwe + Iwh + Iap of which increased by 10% in five years (Table) were excluded from this study because the clay films of these samples might have been overheated or incompletely dried before the first X-ray analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Study of oval crystals in urine].

Urinary crystals were collected by repeated centrifugation from two outpatients with calcium oxalate crystalluria where oval forms predominated and were studied by scanning electron microscopy and X-ray diffraction. Fibrous structure, biconcave surface and prismatic appearance of oval crystals were shown. The side view of oval forms may be prismatic X-ray diffraction patterns of urinary crystals indicated that oval crystals consist of calcium oxalate monohydrate.

[Testicular metastasis of multiple myeloma: a case report].

A 49-year-old man was admitted to our department with the complaint of right scrotal painless swelling in May 1986. The patient had been treated for multiple myeloma since November 1985. Right orchiectomy was performed under the diagnosis of malignant testicular tumor. The right scrotal mass was 5 x 7.5 x 3.5 cm in size. Histological diagnosis was testicular metastasis of multiple myeloma. Testicular metastasis of multiple myeloma is very rare and only 5 cases have been reported in the Japanese literature. The 6 cases including our case with testicular metastasis of multiple myeloma in Japan are reviewed.

[A case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder].

We report a case of carcinomatous meningitis from transitional cell carcinoma of the urinary bladder. A 70-year-old man with invasive bladder cancer and multiple pulmonary metastases received 3 courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, and cisplatin) chemotherapy, after which the primary tumor and pulmonary metastases diminished in size and number. During the 4th course of chemotherapy, he complained of nausea, headache, diplopia, and neck stiffness. Computer tomographic (CT) scan of the brain showed no evidence of parenchymal metastases, cerebral hemorrhage, or infarction. Cerebrospinal fluid examination revealed an increase in cells along with elevated protein and depressed glucose concentrations, but no malignant cells were identified. He died two weeks after the onset of neurological symptoms. Autopsy revealed numerous tiny metastatic lesions in the leptomeninx, so called carcinomatous meningitis, without parenchymal metastases in the brain. Although metastases to the central nervous system from transitional cell carcinoma of the bladder, especially carcinomatous meningitis rarely have been reported, this unusual complication will be seen more frequently with the development of more effective systemic chemotherapy such as M-VAC.

[Fournier's gangrene: a case report].

A 40-year-old male was admitted complaining of high grade fever, pain, redness and swelling of the right scrotum, right perineum and right flank region. He had no apparent history of previous infection or diabetes mellitus. At the time of admission, the scrotum was partly necrotic with repulsive feculent pus discharge and there was crepitus on palpation of involved areas. Culture of purulent discharge yielded the growth of anaerobic organisms. Surgical drainage was performed immediately and debridement of necrotic tissue in the involved areas was often repeated. At the same time, the patient received antibiotic therapy that included agents effective against anaerobic bacteria. However, the scrotal skin developed gangrene and the right testis hung suspended with cord exposed. This testis was intact. The scrotal skin defect was cured using a skin graft, after the infection had been brought under control.

[Foreign body stone of the ureter as a complication of acupuncture: report of a case].

A 47-year-old female was admitted to our clinic with the suspicion of ureteral foreign body. She had undergone acupuncture for left lumbago twelve years earlier. Plain X-ray film revealed a linear shadow and calcified shadows laterally to left third lumber vertebra. Computed tomographic scan and pyelogram showed them located in the left ureter. Left ureterolithotomy was performed successfully. The removed stone was accompanied by an acupuncture needle. Including our case, twelve cases of foreign bodies as a complication of acupuncture in the upper urinary tract reported in the Japanese literature were reviewed.

[Percutaneous dissolution of uric acid and cystine stones causing acute ureteral obstruction].

Four cases with ureteral obstruction due to uric acid or cystine stones were treated successfully by percutaneous irrigation with sodium bicarbonate or tromethamine-E. These cases underwent percutaneous nephrostomy for the reason of prolonged complete obstruction (case 1), sustained pyelonephritis (case 2) or decreased renal function (case 3 and 4). Two catheters were placed through the nephrostomy tract before irrigation, 6 Fr. ureteral catheter just above the ureteral stone and 10 Fr. pigtail or 12 Fr. Malecot catheter in the renal pelvis. The ureteral stones were markedly reduced in size and passed spontaneously after 6-11 days' duration of irrigation in three cases. In case 2, the remaining stone was removed transurethrally after 14 days' duration of irrigation, and was found to be composed of organic matrix. Percutaneous dissolution is considered to be a safe and reliable method and may be an alternative way of treating uric acid or cystine stone causing acute ureteral obstruction.

[Etiology and prognosis of renovascular hypertension].

Eleven cases of renovascular hypertension treated by the authors during the 10-year period from 1974 to 1984 are summarized in this paper, referring particularly to its etiology and prognosis. The causative diseases included 3 cases of atherosclerosis, 4 cases of fibromuscular dysplasia, 1 case of aortitis syndrome, 1 case of abdominal aneurysm, 1 case of renovascular thrombosis, and 1 case of unknown origin. Operations were given in 10 of the 11 cases i.e., 7 cases of nephrectomy and 3 cases of reconstructive surgery for renal blood-flow. The results of operations at discharge were 7 cases of blood pressure normalization, 2 cases of its improvement and 1 case of no change. There was no operative mortality. The outcome of long followup revealed that 2 of the 3 patients with atherosclerosis died in 9 months and 1 year and 10 months, respectively, due to cerebral hemorrhage and renal failure. However, the patients with other diseases maintained their health for 5 years and 5 months (mean observation period), with normal blood pressure or a mild hypertension. Sometimes, in patients with atherosclerosis in whom severe arteriosclerotic lesions already exist in the cardiovascular system, conservative therapy is better than surgical therapy. The indication for surgical therapy, should be made after considering the results of the angiotensin II analogue test.

[A case of renal cell carcinoma during pregnancy].

Renal cell carcinoma during pregnancy is extremely rare. This 30-year-old patient was first seen on Dec. 18, 1983 at the 7th week of her 2nd pregnancy. She had asymptomatic hematuria. Cystoscopy revealed normal findings and sonogram showed well defined echogenic mass in the upper pole of the right kidney. She was admitted to our hospital on account of gross hematuria and severe lumbago on Jan. 19, 1984. The pregnancy was stopped by artificial abortion. Renal angiography revealed a rich-vascularized tumor in the upper pole of the right kidney. Preoperatively, arterial embolization was done and nephrectomy was performed. Histological examination showed a well-differentiated adenocarcinoma. There was no involvement of the renal vein and no lymph-node metastases were found in the operation specimen. The post-operative course was uneventful. This rare case of renal cell carcinoma during pregnancy is herein reported along with some discussion.

[The significance of serum gamma-seminoprotein in prostatic cancer].

The level of serum gamma-seminoprotein (gamma-Sm) was determined by enzyme immunoassay using an EIA gamma-Sm test kit in 32 patients with prostatic cancer (before treatment for 12 and after treatment was started for 20), 24 patients with benign prostate hypertrophy and 22 patients with other urogenital cancer. A gamma-Sm level of over 4.0 ng/ml was considered to be positive. The positive rate was 43.8% in prostatic cancer patients (83.3% before and 20.0% after treatment), 25.0% in benign prostate hypertrophy and 0% in other urogenital cancer. Since the positive rate of prostatic acid phosphatase (PAP) was 34.3% in prostatic cancer patients (75.0% before and 10.0% after treatment) and 16.7% in benign prostate hypertrophy patients, gamma-Sm may be more sensitive but less specific as an indicator of prostatic cancer in PAP. In 9 patients with prostatic cancer before treatment, the levels of serum gamma-Sm and PAP were serially determined for up to 11 months. The level of gamma-Sm decreased in 7 patients, and PAP in all patients after hormone therapy. One patient showed a consistently positive gamma-Sm level and the level of the others became positive only for gamma-Sm during follow-up. There was a statistical correlation between the levels of serum gamma-Sm and PAP in patients with prostatic cancer (r = 0.595, p less than 0.01), in patients with benign prostate hypertrophy (r = 0.882, p less than 0.01) and also in the patients in both groups together (r = 0.590, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical evaluation of serum S100ao protein in patients with urogenital diseases and healthy volunteers].

We investigated the clinical significance of the serum S100ao protein in patients with urogenital diseases. The serum levels of S100ao protein were measured in 179 patients with urogenital diseases and 180 healthy volunteers. The mean value of S100ao protein in serum from healthy volunteers was 203 +/- 107 pg/ml (Mean +/- SD). Therefore, the cut-off level was set to 524 pg/ml (Mean +/- 3SD). The levels of S100ao protein in serum were significantly higher in men than in women (P less than 0.05). The levels of S100ao protein in serum were significantly high in the patients in their fifties and sixties compared with the other patients (P less than 0.01). When serum levels exceeding the cut-off level were considered to be positive, the percentages of positivity in each disease were as follows: renal cell carcinoma; 38.7%, bladder tumor; 9.1%, prostatic carcinoma; 12.5%, testicular tumor; 0%, benign prostatic hypertrophy; 7.4%, urolithiasis; 7.1% and chronic renal failure; 100%. The levels of S100ao protein in serum were significantly correlated with those of BUN, serum creatinine and endogenous creatinine clearance, respectively. S100ao protein in serum was increased immediately after operation and returned to the normal range within one to two weeks after operation. As described above, the level of S100ao protein in serum was affected by renal function, operative procedures and age. However, the positive rate of S100ao protein was so high in patients with renal cell carcinoma that serum S100ao protein might be a valuable tumor marker in those patients.

[Clinical study of total cystectomy in patients with bladder transitional cell cancer].

The late results on 53 patients with bladder transitional cell cancer, who were treated by total cystectomy at the Department of Urology, Jichi Medical School between 1974 through 1983, were reviewed. The ages ranged from 28 to 78 years old, with an average of 61.8 years. There were 48 men and 5 women, with a male to female ratio of 9.6:1. The relative 5-year survival rate was 58.2% as a whole, that of patients with low grade cancer (grade 1 and 2) was 116%, and that of patients with high grade cancer (grade 3) was 33.8%. A significant difference was observed (p less than 0.01). The relative 3-year survival rate of low stage cancer (pT1 and pT2) was 88.4%, that of high stage cancer (pT3 and pT4) was 16.6%, a significant difference being observed (p less than 0.01). The post operative mortality rate was 5.7%.

[A case of leiomyosarcoma of the renal vein].

A 54-year-old woman presented with a 6-month history of left back pain. She had undergone left mastectomy for breast cancer in 1993 and hysterectomy for cervical cancer in 1997. Excretory urography showed no abnormality in the left collecting system, but right hydronephrosis caused by a midureteral stone. She was treated by transurethral ureterolithotripsy first. Computerized tomography showed a 4 x 3 cm. mass enhanced slightly by contrast medium at the left renal hilus. The tumor was bordered laterally by the left kidney and posteriorly by the left renal vein which appeared normal on magnetic resonance imaging. Selective left renal angiography revealed no abnormality. Radical en bloc excision of the tumor with the left kidney and adrenal gland was performed. Pathological examination showed a well differentiated leiomyosarcoma arising from the renal vein; the tumor cells stained positive for alpha-smooth muscle actin, vimentin and desmin and negative for S 100-protein. She was free of symptoms and there was no evidence of local recurrence or distant metastases 22 months postoperatively.