Gonadal function in patients with testicular germ cell tumors.

The gonadal function of 18 patients with testicular germ cell tumors was evaluated. Seminal parameters after orchiectomy were examined in 15 patients. Six of them were available for follow-up observation after 2 or 3 courses of adjuvant chemotherapy. Serum gonadal hormones before and after orchiectomy were evaluated in 7 patients (testosterone and PRL were not examined in one patient). Five of 15 (33.3%), 8 of 15 (53.3%), 13 of 15 (86.7%), 7 of 13 (53.8%), and 9 of 12 (75.0%) had abnormal values in seminal volume, sperm concentration, motility, morphology, and vitality, respectively. The sperm concentration gradually improved after chemotherapy following orchiectomy in 5 of 6 (83.3%) patients. In all the patients examined, serum levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) increased after orchiectomy. Serum levels of testosterone increased in 4 patients, but decreased in 2 after orchiectomy. These findings suggest that several factors, including preexisting intrinsic defect and disturbance of the hypothalamus-pituitary-gonadal axis, are involved in the deterioration of gonadal function in patients with testicular germ cell tumors.

Leiomyoma of the prostate: CT and MR findings.

Pure prostatic leiomyoma is very rare. We report a case of magnetic resonance imaging findings of prostatic leiomyoma. The mass was expansile and had a slightly higher signal intensity than skeletal muscle on T2-weighted images. Normal prostatic glandular tissue could be clearly distinguished from the tumor.

[Anesthetic management of a patient with von Recklinghausen disease complicated with spinal tumor and severe spinal deformity].

We had three occasions of giving anesthesia to a patient with von Recklinghausen disease complicated with spinal tumor and spinal deformity. A 49-year-old male patient who had suffered from von Recklinghausen disease since 35 years of age developed slight low respiratory function due to neurofibroma in the spinal canal and the paravertebral lesion and severe kyphoscoliosis in the lumbar spine which were checked by lumbar X-ray, abdominal ultrasonography and computed tomography during the preoperative period. Transurethral biopsy of the bladder tumor, internal urethrotomy for the urethral stricture and vesical lithotripsy for the bladder stone were performed under general anesthesia. Elevated position of his head and lower extremities and slight right lateral decubitus position were employed during anesthetic induction and semi-Trendelenburg's position during anesthetic maintenance. Convalescence after each operation was uneventful. He was comfortable and had a safe perioperative course. He showed no unward change in neurological symptoms during the post-operative period. This case suggests that we must take the complication such as spinal tumor and spinal deformity into consideration for anesthetic management of patients with von Recklinghausen disease and select the appropriate anesthetic method and patient's position.

Orientation of iron bleomycin and porphyrin complexes on DNA fibers.

Bleomycin (Blm) is an antitumor agent that requires iron and oxygen for strand cleavage of DNA. In this study, ferric bleomycin, Fe(III)Blm, or the nitric oxide adduct of ferrous bleomycin, ON-Fe(II)Blm, were bound to one-dimensionally oriented DNA fibers. Reductive nitrosylation of Fe(III) complexes took place in situ on B-form DNA fibers. Electron paramagnetic resonance (EPR) spectra were obtained as a function of the angle phi between the magnetic field B and the fiber axis Zf. For comparison, EPR spectra were acquired for ON-Fe(II)TMpyP and ON-Fe(II)TMpyP-Im on oriented DNA fibers, where TMpyP is 5,10,15,20-tetrakis(1-methyl-4-pyridino)porphyrin and Im is imidazole. EPR spectra showed both low-spin Fe(III)Blm and ON-Fe(II)Blm bound to B-form DNA in two slightly different binding orientations in the ratio of 1:0.2. With A-form DNA, a fraction of bound Fe(III)Blm was high spin. Specifically, the angle beta between the fiber axis Zf and the g axis, gz, perpendicular to or nearly perpendicular to the equatorial plane of the iron complex was estimated as 20 degrees and 25 degrees for ON-Fe(II)Blm and 30 degrees and 25 degrees for Fe(III)Blm, respectively. The angle gamma that determines the orientation of gx and gy axes was estimated as 90 degrees for the two ON-Fe(II)Blm species and 10 degrees for the two Fe(III)Blm species, respectively. The NO was held rigidly in place as the temperature increased from 123 K to room temperature for ON-Fe(II)Blm but not for ON-Fe(II)TMpyP or ON-Fe(II)TMpyP-Im. It is hypothesized that the NO is structurally oriented by hydrogen bonding like the peroxide is held in HO2(-)-Co(III)Blm (Wu et al. J. Am. Chem. Soc. 1996, 118, 1281-1294). The EPR parameters are consistent with a six-coordinate complex for ON-Fe(II)Blm, although the superhyperfine structure from the trans nitrogen was not detected. The increase in g value anisotropy upon binding ON-Fe(II)Blm to DNA fiber may be caused by an increase in the overlap of d pi and 2p pi* orbitals induced by an interaction of NO with DNA and/or by a perturbation of d orbitals due to the pyrimidine-guanine interaction. It is concluded that the EPR parameters of ON-Fe(II)Blm and Fe(III)Blm bound to oriented DNA support the hypothesis that FeBlm species bind to DNA with adduct structures similar to those formed by related CoBlm species and DNA.

Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: an initial clinical study.

BACKGROUND: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods. METHODS: Fifteen patients with upper tract hematuria of unknown etiology were the subjects of the present study. Prior to ureteropyeloscopy, they underwent standard diagnostic methods, including cystourethroscopy, excretory urography and computed tomography scan. The upper tract (ureter, renal pelvis and calyces) was inspected systematically with a flexible ureteropyeloscope under epidural anesthesia. A biopsy specimen was obtained when neoplasm of a suspicious lesion was seen. Bleeding and hemangiomatous lesions were fulgurated at the time of ureteropyeloscopy. RESULTS: Unilateral gross hematuria was seen in 12 patients. Imaging studies revealed a filling defect in four patients, ureteral stenosis in one patient and nutcracker phenomenon in one patient. Urine cytology was positive in three patients and suspicious in four patients. Results of ureteropyeloscopy were papillary tumor in three patients, whitish encrustation in one patient, redness of the renal pelvis in one patient, bleeding from the renal calyx in two patients, hemangiomatous lesion in one patient, ureteral stenosis in two patients and no abnormalities in five patients. Biopsies were performed in five patients. The pathology results were transitional cell carcinoma in four patients and no abnormality in one patient. Although a ureteral stent catheter was placed in one patient, no serious complications were encountered during or after the procedures. CONCLUSIONS: Ureteropyeloscopy was useful and relatively safe. This endoscopic examination can differentiate insignificant lesions from significant lesions by visual inspection of the lesions, in addition, pathological diagnosis by biopsy specimen can also be performed if deemed necessary. Ureteropyeloscopy is recommended in the diagnosis of upper tract hematuria of unknown etiology.

Overexpression of c-met proto-oncogene associated with chromophilic renal cell carcinoma with papillary growth.

Various genetic changes are involved in human renal cell carcinomas (RCCs). However, the molecular events related to other cytomorphological subtypes of RCC are not well known, apart from the relationship between the von Hippel-Lindau tumour suppressor gene and clear cell subtype RCC. We examined the overexpression of several growth factor receptors immunohistochemically and analyzed their relationship to the cytomorphological characters in 120 cases of RCCs. These receptors included c-met proto-oncogene product (c-MET), epidermal growth factor receptor (EGFR) and transforming growth factor beta receptor II (TGFbetaR). The overexpression of c-MET was detected in all cases (20/20) of the tubulo-papillary growth type and 78.3% (18/23) of chromophilic cell subtype, resulting in a very significant associations between c-MET overexpression and tubulo-papillary growth RCCs (P<0.0001), c-MET and chromophilic subtype RCCs (P<0.0001), and c-MET and EGFR (P<0.0001). EGFR overexpression was significantly associated with the compact growth RCCs (49/89, P<0.0001), clear cell subtype RCCs (P<0.005) and the overexpression of TGFbetaR (P<0.0001). These results strongly suggest a close correlation between the overexpression of c-MET and development of the chromophilic subtype of RCC with papillary growth pattern. EGFR expression is closely related to the pathogenesis of the clear cell subtype of RCC with compact growth pattern. The overexpression of c-MET, EGFR, and TGFbetaR may have roles that are individually significant in the morphogenesis of RCC.

[Clinical studies on the quality of life in patients with ileal conduit].

Between August, 1985 and December. 1995 ileal conduit was performed in 36 cases of bladder cancer (30 males, 6 females). A survey based on a questionnaire was carried out on 15 patients to assess their quality of life (QOL) after the surgery. The questionnaire dealt with the working situation, appetite, sleep, defecation, bathing, travel, general health condition, satisfaction, sexual life and erection. Although only 64.0% of the patients returned to work, appetite, hours of sleep and bathing frequency showed only a slight decrease. We performed total cystectomy without using the nerve sparing method. After the operation, three patients could have an erection and enjoy sexual life. Because the ileal conduit resulted in few complications and only a slight reduction in QOL, it was considered an appropriate operation.

[A clinical study of superficial bladder cancer with grade 3 components].

A retrospective study was done on 33 patients treated for superficial bladder cancer, pTa and pT1, with grade 3 components between 1986 and 1995. All patients had undergone transurethral resection of the tumor (TUR-Bt), which was followed by total cystectomy in 7 patients. Three patients died of pulmonary diseases or heart attack and 6 patients subsequently died of bladder cancer. The 2-year and 5-year disease-specific survival rates of these patients were 83% and 75%, respectively, and the mean duration of follow-up was 50 months. Comparison of the disease-specific survival rates for several factors revealed that the configuration and size of the tumors were significantly predictable factors for prognosis. In well-selected patients with grade 3 superficial bladder cancer, bladder preservation seems to be possible by TUR with or without adjuvant therapies. Hence further studies on a larger series are needed to elucidate more feasible and reliable prognostic factors to avoid unnecessary cystectomy and improve the quality of life of the patients.

Overexpression of c-Met/hepatocyte growth factor receptors in human prostatic adenocarcinoma.

Hepatocyte growth factor (HGF) and c-met proto-oncogene product (c-Met) have varied biological functions in different tissues and have been implicated in mitogenic, motogenic and morphogenic responses in both organ regeneration and carcinogenesis. Some studies have suggested that the overexpression of c-Met and epidermal growth factor receptor (EGFR) are associated with growth advantage, while transforming growth factor-beta receptor II (TGF beta R II) is associated with growth disadvantage of human prostatic adenocarcinoma. However, it is unclear if the expression of c-Met correlates with the expression of EGFR and TGF beta R II, and with the proliferative status of human prostatic adenocarcinoma. Using immunohistochemical staining with anti-c-Met (C-12), anti-EGFR (NCL-EGFR) and anti-TGF beta R II (L-21) antibodies, we determined the frequency of expression of c-MET, EGFR, and TGF beta R II respectively in a series of 134 radical prostatectomy specimens. We evaluated the relationship between the expression of these receptors and clinicopathological characteristics. Overall, c-Met immunostaining was detected in 54 of 134 (40.3%) cases, EGFR in 45 (33.6%) and TGF beta R II in 64 (48.4%). The overexpression of c-Met was significantly more common in poorly differentiated (P < 0.0001) and in the diffusely infiltrated specimens (P < 0.0005). In contrast, TGF beta R II was significantly overexpressed in the well differentiated specimens (P < 0.0001) and associated negatively with c-Met (P < 0.0001). Overall, these data suggest that c-Met/HGF receptor and TGF beta R II overexpression may be involved in the differentiation of human prostatic adenocarcinoma, c-Met with de-differentiation and TGF beta R II with differentiation.

Immunohistochemical studies of proliferating cell nuclear antigen and cathepsin D in transitional cell carcinoma of the urinary bladder.

Immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and cathepsin D was performed on 60 transitional cell carcinoma (TCC) specimens from 60 patients with bladder cancer. The percentage of PCNA-positive cells (PCNA-labelling index) was determined by counting 500 or 1,000 cells, and cathepsin D expression was graded according to the extent of immunoreactivity to anti-cathepsin D antibody. The PCNA-labelling index was significantly higher in high-grade and high-stage tumors compared to that in low-grade and low-stage tumors. Cathepsin D was highly positive in grade-1 tumors. In contrast, 82% of grade-3 tumors and 76% of advanced tumors showed negative or low reactivity to anti-cathepsin D. Groups of high PCNA-labelling index and negative cathepsin D had significantly poorer prognoses compared to those of the low PCNA group and cathepsin D highly positive group, respectively, in univariate analyses. However, neither of these two factors were independent prognostic factors in multivariate analyses. These results suggest that the PCNA-labelling index and cathepsin D expression may indicate the malignant potential of TCC and may be able to provide additional information for predicting survival when stratifying for grade of bladder cancer.

[Synchronous bilateral renal cell carcinoma in mass examination: a case report].

A 65-year-old female with bilateral renal cell carcinoma which was incidentally found by general check-up developed left hemiplegia following left nephrectomy. Marked metastasis of cervical spine was demonstrated by computerized tomography scanning, which was not evident before the operation by X-ray examinations. The patient died of respiratory paralysis one month after the operation. This case was difficult to treat, because the disease advanced so rapidly.

[Surgical exploration for renal cyst: two-case report].

A 59-year-old male was admitted to our clinic for further examination of the calcified renal cyst discovered incidentally on medical workup elsewhere. CT showed a left renal cyst associated with calcification. Ultrasound-guided puncture of the renal cyst was not successful because of thickness of the cystic wall. Renal angiography showed hypervascularity of the cystic wall. Association of renal cell carcinoma could not be ruled out, therefore the exploration was performed. Histological examination revealed benign renal cyst with calcification. A 27-year-old male presented with the chief complaint of left flank pain. Following examinations by US, CT and MRI, a renal cyst associated with renal cell carcinoma was highly suspected. Subsequent exploration revealed cluster of cysts with a yellowish lesion a few mm in diameter. Frozen section revealed no malignancy, and cystic fluid was not hemorrhagic. Therefore as many cystic walls as possible were removed without nephrectomy. Histological examination of the permanent specimen revealed renal cell carcinoma. Renal cyst associated with renal cell carcinoma was regarded as rare clinical entity, but such cases are reported in increasing number in recent years. We report such cases and review the pertinent literature in this paper.

Recombinant human interleukin-1 beta analogue as a regulator of hematopoiesis in patients receiving chemotherapy for urogenital cancers.

Ten patients with advanced urologic cancers who were scheduled to receive at least two courses of chemotherapy were enrolled in this trial. Fifty thousand units of recombinant human interleukin-1 (IL-1) beta analogue OCT-43 (Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan) was administered subcutaneously only once or twice when severe neutropenia (less than 500/microliters) continued for 2 consecutive days. In eight patients, OCT-43 was not injected in the first course of chemotherapy as a control, but was injected in the second course. The durations of leukocytopenia (less than 2000/microliters) and neutropenia (less than 1000/microliters) were significantly shortened in the second course compared with those in the first course in those eight patients. Recovery of neutrophil number from the lowest number was also significantly faster in the second course. Thus, OCT-43 was considered to have hematopoietic activities. However, single or double injection of OCT-43 did not affect the numbers of eosinophilic or basophilic granulocytes, monocytes, or platelets. Adverse effects associated with OCT-43 injections were high fever and chills, but they were controlled by indomethacin.

[Clinical study of renal cell carcinoma as incidental finding].

Reports on renal cell carcinoma (RCC) as an incidental finding have been increasing in recent years as the imaging modalities including ultrasonography (US) and computerized tomography (CT) scan have gained popularity in clinical medicine. Because effective treatment in RCC is only surgical removal of the involved kidney even at present, it is imperative for urologists to find and to diagnose the RCC in early stage. Whether RCC found incidentally is in early stage cancer is not determined at present. To determine if the RCC found incidentally is in early stage cancer and if the survival rate is better than that of the RCC found with symptoms, we undertook the following study. Between December 1972 and March 1990, 65 patients with RCC were registered at the Department of Urology, Teikyo University Hospital. Of 65 patients 20 with RCC as an incidental finding were subjected to this study. 34 patients with RCC found with symptoms including hematuria were subjected to control group. Causes of the diagnosis in 20 patients included workup for non-urological diseases in 11 patients (55.0%), workup for urological disease other than RCC in 5 patients (25.0%) and routine medical checkup in 4 patients (20.0%). First-line imaging modalities for the diagnosis was US in 9 patients (45.0%), DIP in 6 patients (30.0%) and CT in 5 patients (25.0%). Size of the tumor, pathological stage (pT) and grade in these 20 patients were tended to be smaller and lower, respectively, but these results were not significant as compared to those of the control group. Incidence of the remote metastasis, at the time of diagnosis, however, was significantly lesser than that of the control group (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)