[Arterial injury associated with tension-free vaginal tape procedure successfully treated by radiological embolization: a case report].

A 75-year-old woman underwent a tension-free vaginal tape (TVT) procedure for urinary stress incontinence. The patient complained of lower abdominal pain, a feeling of lower abdominal distension and nausea three hours after the operation. In addition, systolic blood pressure decreased gradually to 80 mmHg. Enhanced computed tomography revealed a retropubic hematoma sized up to 16 cm X 12 cm X 11 cm and bleeding from a vessel running through the posterosuperior aspect of the pubic bone. Successively, arteriography was performed. The arteriogram also confirmed arterial injury, which was successfully treated by selective embolization using a gelatin sponge and pushable coils. Postoperative course was uneventful requiring neither blood transfusion nor surgical removal of the hematoma.

[Adrenal ganglioneuroma in a 14-year-old girl: a case report].

A 14-year-old girl was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal ultrasound sonography. Computed tomographic scan and magnetic resonance imaging showed a 44 x 20 mm solid tumor in the right adrenal region. Endocrinological examination were within normal limits except for slightly increased serum aldosterone. Laparoscopic adrenalectomy was performed and the tumor was histologically diagnosed as ganglioneuroma originated from the right adrenal medulla.

[Intraarterial chemotherapy with bladder preservation in patients with invasive bladder carcinoma].

Intraarterial chemotherapy (IAC) was carried out on patients with invasive bladder carcinoma to treat the bladder carcinoma while preserving the bladder. Fifteen patients with bladder carcinoma at stage T2-T4 were treated with intraarterial cisplatin (CDDP: 70 mg/m2) and adriamycin (ADM: 30 mg/m2) every 3 to 4 weeks. The response was observed in all 15 patients. Ten (66.7%) achieved a complete response (CR), and 3 (20.0%) obtained a partial response (PR). With a mean follow-up of 22.6 months, the overall survival rate was 86.7% and 12 patients were alive with functioning bladder. One patient received radical cystectomy. Although further studies and long-term follow up are required to clarify its effectiveness, IAC for patients with invasive bladder carcinoma might be an effective therapy with a preserved bladder.

[Reiter syndrome after intravesical Bacillus Calmette-Guerin (BCG) immunotherapy: a case report].

A 56-year-old man who had previously undergone transurethral resection and intra-arterial chemotherapy for bladder cancer developed irritable bladder, bilateral conjunctivitis and arthritis including the knees, ankles and sacroiliac joints after starting intravesical Calmette-Guerin bacillus (BCG) immunotherapy. These symptoms were in agreement with the features of Reiter syndrome. One month after cessation of the intravesical BCG immunotherapy and initiation of the treatment with a non-steroidal anti-inflammatory drug (NSAID), he was not complaining of symptoms. Reiter syndrome is an uncommon complication after intravesical BCG immunotherapy. Nevertheless, since the prolonged arthritis has a possibility to cause joint deformity, we must pay serious attention to this side effect.

[Retroperitoneal angiomyolipoma with rapidly progressing intracystic hemorrhage and lymph node involvement: a case report].

We report a very rare case of retroperitoneal angiomyolipoma with rapidly progressing intracytic hemorrhage and lymph node involvement in a 34-year-old female. She was admitted to our hospital complaining of a severe pain in the lower abdominal region, followed by oligemic shock. Abdominal enhanced computed tomography (CT) demonstrated a retroperitoneal giant cyst with intracystic hematoma, which displaced the left kidney anteriorly. Because transarterial embolization was unsuccessful transabdominal left nephrectomy combined with excision of the giant cyst was performed to keep the continuing hemorrhage under control. Simultaneously, a swollen paraaortic lymph node was also resected. The histologic findings of resected tissue and lymph node were retroperitoneal angiomyolipoma with lymph node involvement. The patient is being followed up at our hospital without recurrence.

[A case of ammonium urate urolithiasis with Crohn's disease].

A 28-year-old woman suffering from Crohn's disease since 15 years of age presented with left back pain. She had undergone a colectomy when she was 20 years old and an ileostomy when she was 25 years old. She had been treated with mesalazine and pernasal nutrition (Elental) Ultrasonography showed left side hydronephrosis and a renal stone in the left renal pelvis. Computed x-ray tomography revealed a stone measuring 1.5 x 1.0 cm2 at the ureteropelvic junction, which was radiolucent on an abdominal radiograph. The renal stone was successfully treated with 10 exposures of extracorporeal shockwave lithotripsy. Ninety eight percent of the passed stone was composed of ammonium urate. Crohn's disease-related poor nutrition and dehydration are presumed to have been possible induction factors in the forming of the ammonium urate stone in this case.

[Angiosarcoma of the spleen 11 years after chemotherapy for testicular seminoma: a case report].

A 32-year-old man who had previously undergone chemotherapy for testicular seminoma 11 years ago was admitted to our hospital with a pain in the right leg. Computed tomography (CT) and bone scintigraphy revealed splenomegaly and multiple bone disease. Laboratory examination showed thrombocytopenia. The pathologic diagnosis of the resected spleen and the biopsied rib was angiosarcoma. We found no reports of angiosarcoma following previous chemotherapy for testicular cancer. It is unclear whether the angiosarcoma is a secondary neoplasm induced by the chemotherapy or not. However, the patient had a chromosomal aberration of the peripheral lymphocytes. The chemotherapy might also have affected the chromosomal aberration presumably in endothelial progenitor cells causing the development of a secondary neoplasm. To our knowledge, this is the first case of angiosarcoma after chemotherapy for testicular seminoma.

[2,8-dihydoroxyadenine (DHA) urolithiasis: a case report].

We report a case of 2,8-dihydroxyadenine (DHA) urolithiasis in a 28-year old female. She was admitted to our hospital complaining of a sudden pain in the left lumbar region. Abdominal X-ray (kidney-ureter-bladder; KUB) and computed tomography (CT) demonstrated a radiolucent left ureteral (8 x 6 mm2) and a renal (15 x 10 mm2) stone. In the repetitive procedure of transurethral ureterolithothripsy (TUL) and extracorporeal shock wave lithotripsy (ESWL), the stones had been removed successfully. The spectrophotometric analysis of the stone fragments revealed an absorption spectrum for 2,8-DHA. Adenine phosphoribosyltransferase (APRT) enzyme activity was lowered to 0.8 nmol/hr/mg protein. Thus, we diagnosed the illness as 2,8-DHA urolithiasis originating from APRT deficiency. A molecular analysis of the APRT gene by the polymerase chain reaction (PCR) method revealed the genotype to be APRT*J/APRT*Q0.

Reducing the agonist activity of antiandrogens by a dominant-negative androgen receptor coregulator ARA70 in prostate cancer cells.

Although the progression of prostate cancer initially is dependent on androgens, tumor progression to an androgen-independent growth eventually occurs in most of patients treated with androgen ablation and/or antiandrogen therapy. After the initial response, antiandrogens lose their efficacy and eventually act as agonists to promote androgen receptor (AR)-mediated growth of prostate cancer cells. An aberrant regulation of AR activity, presumably by AR coregulators, may contribute to this acquired agonist activity of antiandrogens. Using an in vitro mutagenesis and a double-negative selection in yeast two-hybrid screening, we have identified a dominant-negative AR coregulator ARA70 (dARA70N), which can inhibit AR transcriptional activity by inactivating the normal function of ARA70 in the LNCaP cells. Whereas ARA70 in oligomeric form interacts with AR and enhances its transcriptional activity, dARA70N lacks AR interaction and might retain the ability to form a non-functional heteromer with ARA70 and interrupt AR transcriptional activity without a change in AR protein itself. The addition of dARA70N reduces the agonist activity and rescues the normal function of antiandrogens in prostate cancer cells. RNA-interference-mediated silencing of ARA70 gene further confirms these observations. Taken together, these findings indicate that ARA70 may contribute to the acquired agonist activity of antiandrogens and plays an important role in making prostate cancer cells resistant to androgen ablation and/or antiandrogen therapy. ARA70 may, thus, be a critical target for developing therapeutic agents against AR-mediated progression of prostate cancer.

[Hormonal chemotherapy for hormone-refractory prostate cancer].

To our knowledge, no standard chemotherapy for patients with hormone-refractory prostate cancer (HRPC) has been established. Since most patients with HRPC are elderly and have bone metastasis, cytotoxic chemotherapy causes them to be at high risk for myelosuppression. Therefore, chemotherapeutic agents with low toxicity and good compliance should be elected. We conducted three regimens for HRPC on an outpatient basis. Eligibility criteria were defined as serial rising PSA values on 3 or more occasions at least 2 weeks apart or radiological new or extensive lesions under hormonal therapy. The first regimen is comprised of cyclophosphamide (CPM), 100 mg/day, UFT, 400 mg/day, and estramustine phosphate (EMP), 560 mg/day in two daily fractions. The second regimen is comprised of an oral administration of dexamethasone (DEX) (0.5-2 mg/day). The third regimen is comprised of DEX, 1 mg/day, cyclophosphamide, 100 mg/day and UFT, 400 mg/day in two daily fractions. Post-therapy prostate-specific antigen (PSA) level in serum, objective response on bone scan or measurable disease, and symptomatic response on bone pain were assessed. All regimens showed clinical efficacy with mild toxicity. Indications and limitations of these regimens are discussed. Further, the combination trials of taxane and EMP in patients with HRPC are reviewed.

A dominant-negative mutant of androgen receptor coregulator ARA54 inhibits androgen receptor-mediated prostate cancer growth.

The ligand-bound androgen receptor (AR) regulates target genes via a mechanism involving coregulators such as androgen receptor-associated 54 (ARA54). We investigated whether the interruption of the AR coregulator function could lead to down-regulation of AR activity. Using in vitro mutagenesis and a yeast two-hybrid screening assay, we have isolated a mutant ARA54 (mt-ARA54) carrying a point mutation at amino acid 472 changing a glutamic acid to lysine, which acts as a dominant-negative inhibitor of AR transactivation. In transient transfection assays of prostate cancer cell lines, the mt-ARA54 suppressed endogenous mutated AR-mediated and exogenous wild-type AR-mediated transactivation in LNCaP and PC-3 cells, respectively. In DU145 cells, the mt-ARA54 suppressed exogenous ARA54 but not other coregulators, such as ARA55-enhanced or SRC-1-enhanced AR transactivation. In the LNCaP cells stably transfected with the plasmids encoding the mt-ARA54 under the doxycycline inducible system, the overexpression of the mt-ARA54 inhibited cell growth and endogenous expression of prostate-specific antigen. Mammalian two-hybrid assays further demonstrated that the mt-ARA54 can disrupt the interaction between wild-type ARA54 molecules, suggesting that ARA54 dimerization or oligomerization may play an essential role in the enhancement of AR transactivation. Together, our results demonstrate that a dominant-negative AR coregulator can suppress AR transactivation and cell proliferation in prostate cancer cells. Further studies may provide a new therapeutic approach for blocking AR-mediated prostate cancer growth.