Progressive systemic sclerosis associated with primary small cell carcinoma of the stomach.

A 64-year-old man with a 5-year history of progressive systemic sclerosis (PSS) was hospitalized because of melena. Radiological and endoscopic examinations showed an ulcerative lesion with sharply demarcated and raised margins in the fornix of the stomach. Tumor markers--serum carcinoembryonic antigen (CEA, 11.3 mg/ml) and neuron-specific enolase (NSE, 38.9 ng/ml) were elevated. Histological examination of endoscopic biopsy specimens (and of necropsy specimens) showed proliferation of atypical small round cells. Immunohistological examination of these cells showed they were positive for epithelial membranous antigen (EMA), and neuron-specific enolase (NSE), but negative for UCHL1, leukocyte common antigen (LCA), anti-leukocyte B-cell (MB1), and anti-leukocyte T-cell (MT1) antigens. Based on these histological and immunohistological tests, a definite diagnosis of small cell carcinoma of the stomach with PSS was established. Our case is a rare combination of PSS and gastric small cell carcinoma. We also reviewed the literature for the association between PSS and gastric cancer in Japanese patients.

[Urinary interleukin-6 and interleukin-8 in females with urethral syndrome].

Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of an inflammatory response. We measured creatinine-collected urinary levels of IL-6 and IL-8 by an enzyme-linked immunosorbent assay in 21 women with urethritis syndrome as well as 20 age-matched healthy women. Urine samples were collected before treatment and after 7 or 14 days of oral administration of sparfloxacin (100 mg once daily). Urinary IL-6 level was elevated in a patient with urethritis syndrome (41.1 pg/mgCr), while urinary IL-8 levels were elevated in 8 (range 13.3 to 560 pg/mgCr). On the other hand, none of the healthy controls showed any detectable urinary level of IL-6 and IL-8. Of the 9 patients with elevated urinary IL-6 or IL-8, symptomatic improvement was obtained after chemotherapy in 8 and urinary interleukins became undetectable in 7. Urinary IL-6 and IL-8 seem to have some role in the induction of urinary symptoms.

[Statistic study of 1,272 cases of foreign bodies in the bladder or urethra].

The foreign bodies in the bladder or urethra found in the clinical observation of the 41 cases treated between April, 1963 and October, 1982, in our Department and those of 1,231 cases so far reported in Japan, were studied statistically. The incidence was higher in males than in females, the ratio being 1.7:1. This ratio has been unchanged for the past 20 years. Of the foreign bodies removed, the cases of wax and rubber objects have been on the decrease. The urethra has come to occupy an increasingly large percentage of the introductory routes during the past 20 years. Removal through the urethra has become more common owing to the development in the transurethral appliances.

[The impact of upper urinary tract stone diseases on the national economy].

The incidence of upper urinary tract stones is increasing, and it is most often seen in persons in the prime of their lives during their most productive years. It must be taken into account that surgical treatment takes them away from their jobs for long periods of time. We therefore should be careful in choosing a treatment modality for a patient. We evaluated extracorporeal shock wave lithotripsy (ESWL), transurethral ureteroscopy (TUL) and open surgery from the viewpoint of national economy and patient amenity. ESWL offered the fewest hospital days and better amenity, though it was the most expensive. ESWL also offered the fewest days missed from work and this could minimize the loss of national economic productivity. We conclude that as a whole, ESWL is the least expensive therapy in terms of national economy compared with TUL and open surgery.

[A case report: surgical reconstruction of the external genitalia in adrenogenital syndrome].

This is a case report of a 5-year-old girl with congenital adrenal hyperplasia (CAH) who had clitoral hypertrophy and vagina opening at verumontanum between the bladder neck and external urethral sphincter. Female pseudohermaphroditism with CAH is the most common type of intersex problem seen in children. In females with this disorder, the internal genital organs are usually normal, but variable degrees of virilization can be observed externally. We discussed the indication of the surgical correction of ambiguous external genitalia in this syndrome in view of sexual function and cosmetic problems.

[Intravenous urography with a nonionic low osmolality contrast medium (iopamidol) in elderly patients].

Intravenous urography was carried out with a nonionic low osmolality contrast medium, iopamidol (Iopamiron 300) in 30 elderly patients (aged 65 to 86; with the mean age of 75 +/- 6), and the safety for the aged and radiopacity were evaluated. Although no purgative was given and water was not restricted in consideration of dehydration and bad influence on renal function, the total urinary system was well visualized. Side-effect was observed in none of 30 patients. This method seems to be useful for patients with a risk of dehydration and elderly patients.

[A case report: primary hyperparathyroidism--comparison before and after parathyroidectomy by oral calcium tolerance test].

To evaluate the cause of hypercalciuria, we carried out the oral calcium tolerance test before and after parathyroidectomy in a patient with primary hyperparathyroidism who had recurrent and multiple nephrolithiasis. Preoperative laboratory examination showed hypercalcemia, hypophosphetamia, hypercalciuria, decrease in % tubular reabsorption of phosphorus and strikingly elevated urinary cyclic AMP excretion. The oral calcium tolerance test indicated a significantly greater increase in serum calcium (delta serum calcium: 1.4 mg/dl vs 0.8 mg/dl) and a significantly greater suppression of urinary cyclic AMP excretion (delta U-cyclic AMP:-3.56 moles/gCre vs-1.17 moles/gCre) before parathyroidectomy than after. These results showed that hypercalciuria in this case was induced not only by the significant increase in the filtrated load of calcium but by the reduction in the resorption of calcium in the distal tubule caused by the significantly suppressed parathyroid hormone effect.

[Pharmacokinetic study on oxalate in rats].

The pharmacokinetics of oxalate were studied in normal and nephrectomized rats, using radioisotope-labelled oxalate to resolve the mechanism of calcium oxalate stone formation. Plasma disappearance of 14C-oxalate was analyzed with a 2-compartment open model, and each compartment volume, the first-order rate constant for elimination, and the first-order rate constant for transfer between the central compartment and peripheral compartment were obtained. These values were compared with those for inulin. In normal rats, the total distribution volume was 57% of body weight for oxalate and 34% for inulin. The elimination rate constant from the central compartment for oxalate was lower than that for inulin, but oxalate had a much larger central compartment volume than inulin. Thus, the total clearance of oxalate was greater than that of inulin. In nephrectomized rats, total clearance of oxalate decreased to 1/6 of that in normal rats, while total clearance of inulin decreased to 1/27 of that in normal rats. These results suggest that oxalate is more diffusible than inulin, and that oxalate is excreted mainly from the kidney.

[Experience with the Stamey method for stress incontinence and cystocele vaginalis].

Endoscopic needle suspension of the vesical neck (Stamey) was used in 4 cases of stress incontinence and 4 cases of cystocele vaginalis. In cystocele vaginalis, this method was done following anterior colporrhaphy. In postoperative examination of chain cystourethrogram, posterior urethrovesical angle, anterior urethral inclination angle and base plate of bladder were remarkably improved. In the 13 other women with stress incontinence, chain cystourethrogram showed that posterior urethrovesical angle and anterior urethral inclination angle were greater and bladder base plate was lower in the older group (over 50 years) than in the younger group (under 50 years). These results indicated that there were some difference in the factors of stress incontinence between the younger group and older group with stress incontinence.

[Endocrine chemotherapy for prostatic cancer].

We carried out a randomized joint study on endocrine therapy and endocrine chemotherapy for prostatic cancer at our department and 17 affiliated institutions. Of 80 patients entered, 39 patients were treated with chlormadinone acetate alone (group A) and 41 patients were treated with chlormadinone acetate in combination with UFT (group B). After excluding 10 inappropriate patients, Stage C was observed in 14 patients in group A and 13 in group B, and stage D in 20 patients in group A and 23 in group B. Side effects were observed in 8.8% (3/34) in group A and 22.2% (8/30) in group B without a significant difference. The anti-tumor effects (response rate) and clinical effects with respect to each item did not significantly differ between the two groups. The non-recurrence rate and survival rate were significantly higher in group B than in group A. These findings suggest the usefulness of endocrine chemotherapy using UFT.

[Comparative clinical study of single and combination therapy of human lymphoblastoid interferon (HLBI) with 5-FU in the treatment of advanced renal cell carcinoma].

A clinical trial using human lymphoblastoid interferon (HLBI) was done on patients with advanced renal cell carcinoma to compare the efficacy of monotherapy with that of combined administration with a 5-fluorouracil (FU) agent. A total of 24 patients with definitely diagnosed advanced renal cell carcinoma were enrolled in either of the HLBI treatments. Principally, the daily intramuscular injection of 3 million units of HLBI was done for 4 consecutive days and thereafter followed by twice of weekly injections. The combined agent used in the present study was 300 or 600 mg of 5-fluorouracil agent given orally. The efficacy of HLBI was evaluated according to direct assessment standard of chemotherapy to a solid tumor expelled by the committee of Japanese health and welfare ministry. Of 11 patients who received monotherapy, 3 had a partial response rate of 27.3 percent. While only one of 13 patients having received combined HLBI administration with oral 5-FU tablets showed a partial response with a response rate of 7.7 percent. A total of 4 patients partially responded to either HLBI treatment with a subsequent response of 16.7 percent. Partial response implied reduction of lung metastatic foci in 3 patients and primary lesion in one patient. There was observed untoward fever-up in all patients with HLBI injections which was relieved with acquired tachyphylaxis owing to repeated injections. Otherwise minimal adverse effects were temporary elevation of liver transaminase in 4 and leucopenia in 2 patients during the HLBI treatment both of which eventually returned to the normal level without discontinuation of HLBI therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of stone former with pacemaker treated by extracorporeal shock wave lithotripsy].

A stone former, a 60-year-old male with a pacemaker, was treated by extracorporeal shock wave lithotripsy (ESWL). He had been on a DVI pacemaker due to sick sinus syndrome since the age of 52. During treatment for left ureteral stone by ESWL, the pacemaker was stopped, since there was a possibility of extra systoles caused by coupled triggering of the shock wave with the pacemaker spike wave in ECG. Pulse and blood pressure were maintained by continuous drip infusion of phenylephrine chloride and isoproterenol. As a result, ESWL was accomplished and pacemaking was reestablished without any problem. KUB revealed that the patient became stone free on the postoperative 17th day.

[Urolithiasis--a change in therapeutic methods extracorporeal shock wave lithotripsy using a Dornier kidney lithotripter HM3].

The kidney stone of less than 2 cm can be effectively treated by extracorporeal shock wave lithotripsy (ESWL) using a Dornier kidney lithotripter HM3 without any complication that might need other therapy. However, in the case of a large kidney stone and ureteral stone, there are some difficulties in the treatment with ESWL. To obtain better results for these stones with a Dornier kidney lithotripter HM3, in the patient having a large stone a double-J stent was placed and ureteral catheter was indwelling for the ureteral stone before ESWL. In some cases high frequency positive pressure ventilation (HFPPV) was applied to make respiratory movement of the stone minimum. An indwelling double-J stent can significantly decrease the necessity of auxiliary treatment and the incidence of high fever attack. Manipulation of a ureteral stone with a ureteral catheter did not facilitate stone disintegration, and also the success rate as compared with in situ ESWL. HFPPV can decrease the stone movement within 2 mm judged on the X-ray monitor and increase the effectiveness of the shock wave on the stone, leading to minimize not only shock wave dose but also side effects from shock wave exposure.

[Experience with extracorporeal shock wave lithotripsy for urinary stone. Factors for requiring more than two ESWL treatments and its result].

Extracorporeal shook wave lithotripsy (ESWL) was performed for the treatment of 1277 urolithiasis patients at Osaka City University Hospital from July, 1985 to December, 1988. A total of 1788 ESWL treatments were carried out using Dornier HM3 kidney lithotripter. 964 patients (75.5%) underwent only one ESWL treatment, while 313 patients (24.5%) more than two ESWL treatments. We retrospectively examined the factors for requiring more than two ESWL treatments. Not only stone number, size and location, but fragility were considered to be the main causes for requiring more than two ESWL treatments. According to component analysis of ureteral stones, which were hard and resistant to shock wave, calcium apatite content of these stones turned out to be high (p less than 0.001). As for fragility, the residual stones created by ESWL were more difficult to be disintegrated that the nontreated stones of the same size (p less than 0.05). "Fragility" of the stones before shock wave and residual stones after ESWL are considered to be a major problem in ESWL treatment of urinary stones to be solved in the years to come.

[Treatment with a new preparation using peplomycin emulsion in hydroxypropylcellulosum. Analysis of immediate response in sixty-two patients with bladder cancer].

To 62 vesical tumor patients, 30 ml of a HPC-PEP mixed solution was infused into the urinary bladder. The HPC-PEP solution was prepared by adding 15 ml of 2% hydroxypropylcellulosum (HPC) to 15 ml of peplomycin (PEP)/physiological saline solution in which 90 mg PEP had been dissolved. Accordingly, a total of 30 ml of the mixed solution was used. On day 7 after treatment, a clinical evaluation was made through endoscopic observation and urine cytodiagnosis. The results of the evaluation were expressed by assigning appropriate grades for the improvements made. As for the overall clinical effects, 10 patients demonstrated excellent improvement (CR) but 26 patients exhibited no improvement (NC). The overall clinical efficacy for all cases was 58%. When the evaluation was made according to severity (T1, T2, or T3), the results were as follows: of 43 T1 patients, 9 patients were judged CR, and 23 patients were PR; and of 15 T2 patients, 1 patient was CR and 3 patients were PR. However, all T3 patients were NC. The clinical efficacy for the T1 and T2 groups was 74.4% and 26.4%, respectively. A significant difference was observed between the T1 group and the T2 and T3 groups (p less than 0.05). Evaluation made according to the degree of histopathological differentiation (G1, G2 and G3) demonstrated the following results: of 23 G1 cases, 6 cases were CR, 9 cases were PR; of 32 G2 cases, 4 cases were CR and 16 cases were PR; and of 7 G3 cases, only 1 patient was found to be PR.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of acute renal failure due to ethylene glycol intoxication.

We describe an 18-year-old man with acute renal failure due to inadvertent ingestion of antifreeze that contained ethylene glycol (EG). A relatively small amount of EG was ingested, but nausea and vomiting were observed soon after ingestion. During admission to a local hospital, consciousness became impaired and generalized convulsion was noted. He was transferred to our hospital because of rapid deterioration of renal function. Emergency hemodialysis was begun. The patient underwent one treatment session of hemodialysis each day, for a total of 8 hemodialytic sessions before his renal function recovered. Examination of the renal biopsy specimen revealed degeneration of the renal tubular epithelium and presence of intratubular calcium oxalate crystals. The clinical features of the patient were mild except for acute renal failure. These findings suggest that even a small amount of EG will have toxic effects on the kidney.