[Primary signet ring cell carcinoma of the urinary bladder: a case report].

Gross hematuria and urinary frequency caused a 71-year-old man to visit our hospital. A non-papillary tumor was identified on the posterior wall of the urinary bladder and the pathological diagnosis was signet ring cell carcinoma. Upper gastrointestinal endoscopy, computed tomographic scanning, barium enema revealed no involvement of other organs. Radical cystectomy and creation of an ileal conduit were performed. The histopathological stage was pT4N1M0. Apart from subacute ileus, the postoperative course was uneventful. Signet ring cell carcinoma of the bladder is a rare entity and we have identified 41 cases in the Japanese literature. This tumor usually has a poor prognosis. Our patient is currently free from disease at 5 months after the surgery.

[Fornix of vagina suspension for cystocele].

OBJECTIVE: Bladder neck hypermobility causes cystocele in middle to old elderly women. We developed an easy and useful surgical technique for cystocele. METHODS: Thirteen patients with cystocele (grade 2-4) were operated by fornix of the vagina suspension. Patients were placed on lithotomy position under general or spinal anesthesia. Lower midline or lower abdominal transverse incision was made to open the peritoneum and denuded vesicouterine pouch. Several nylon sutures were placed on the lateral side of exposed fornix of the vagina. These sutures were suspended to anterior layer of the rectus sheath. Fornix of the vagina was fixed to the rectus muscle, so the prolapsed bladder wall was pulled up in normal position. RESULTS: Operating time ranged from 15-110 minutes (average 73 minutes). Ten patients of thirteen were successful up to 2-43 months postoperatively. Cystocele recurred in three patients of thirteen. Two patients was re-operated by the same method, but one of them recurred. Two of three recurrent patients had grade 4 cystocele. CONCLUSION: Fornix of the vagina suspension for cystocele seems useful and promising because of easy procedure without serious morbidity, especially in elderly high-risk patients.

A case of diabetic muscle infarction in Japan.

Diabetic muscle infarction (DMI) is a rare complication of diabetes mellitus. We report the first recorded case in Japan. A 45-year-old Japanese woman presented with severe pain in the left antero-medial thigh. She had a 14-year history of Type 2 diabetes mellitus (DM). She had first noticed pain in her left thigh after a walk 2 weeks prior to presentation. The pain worsened progressively. She noticed a firm mass in her left thigh. T2-weighted magnetic resonance imaging (MRI) demonstrated a high-intensity signal in the muscle bulk of the anterior component of the left thigh. A needle biopsy of the mass showed necrosis. She was treated with bedrest and an antiplatelet agent. The mass disappeared 8 weeks after admission. DMI is a rare complication of poorly controlled diabetes mellitus. Twenty-seven cases with DMI have been reported in the English literature but we believe this is the first Japanese case with DMI.

Dietary effects of corn oil, oleic acid, perilla oil, and evening [corrected] primrose oil on plasma and hepatic lipid level and atherosclerosis in Japanese quail.

To compare the atherogenecity of different fats and oils, a total of forty, 40-day-old male Japanese quails were fed one of the following diets for three months: basal diet (control), a diet-containing 15% corn oil (CO) and 2% cholesterol (CH), a diet-containing 15% oleic acid (OL) and 2% CH, a diet-containing 15% perilla oil (PE) and 2% CH, a diet-containing 15% evening [corrected] primrose oil (PR) and 2% CH. A higher plasma cholesterol concentration was found in the birds in the CO and OL groups, whereas the PE and PR groups showed a much lower level of plasma cholesterol than the CO and OL groups. In proportion to the increased plasma cholesterol, both CO and OL groups showed narrowing of the lumen of the ascending aorta and its large branches due to marked lipid-rich intimal thickening. Ultrastructural changes in the ascending aorta and its large branches were correlated with the degree of intimal thickening. The major foam cell types were macrophages and fibroblastic cells. The PE and PR groups showed the fewest lipid-rich intimal thickening lesions in their ascending aorta and its large branches. These findings suggest that the alpha-linolenic acid contained in perilla oil is less atherogenic than oleic and linoleic acid, and gamma-linolenic acid contained in evening [corrected] primrose oil has a tendency to decrease the plasma lipid level.

[A case report of giant cell granuloma of the jaw].

A giant cell granuloma of the mandible seen in a 16 month-old boy was reported. Histopathology showed that the lesion consisted basically of granulation tissue with multinucleated giant cells, spindle-shaped and polygonal stromal cells. No atypia was seen in giant cells or stromal cells. Electron microscopic examination revealed that multinucleated giant cells possessed microvillous structure on their cytoplasm and were rich in organelles such as endoplasmic reticulum, mitochondria and dense bodies. Stromal cells consisted of macrophage-like and fibroblastic cells. Immunohistochemical examination demonstrated a large number of giant cells and stromal cells that were strongly positive for the antibodies of alpha-1-antitrypsin and alpha-1-antichymotrypsin. These morphological findings suggest that macrophage-like stromal cells are the precursors to giant cells.

[Bleomycin-adriamycin combination chemotherapy in squamous cell carcinoma of the lung].

A combination chemotherapy of bleomycin and adriamycin had been carried out in 12 male patients with squamous cell carcinoma of the lung, ranging from 47 to 80 years of age, and were inoperable because of the advanced disease. The method of drugs administration was as follows: Bleomycin was given at a dose of 15 mg by i.v. infusion twice weekly for the first two weeks, and once weekly thereafter until the cumulative dose reached 200 to 300 mg, provided severe toxicity such as pulmonary fibrosis was clinically or roentogenologically proved. Adriamycin was given at a dose of 20mg also by i.v. push twice weekly for the first two weeks, and the same procedure was repeated after a rest period of two to three weeks, until the dose reached nearly approximately a total dose of 200mg if no evidence of cardiotoxicity was observed and bone marrow suppression was negligible. Five cases out of twelve responded well to our bleomycin-adriamycin combination chemotherapy, demonstrating regression of the tumors in 50% or more, although two cases out of these five the responders were treated with radiation additionally. The median survival time of these responders was prolonged as long as 43 weeks, which was considered undoubtedly as favorable outcome, comparing with other clinical reports by others, even though the number of the cases in our clinical trial was rather small.