Low-dose instillation therapy with bacille Calmette-Guérin Tokyo 172 strain after transurethral resection: historical cohort study.

OBJECTIVES: To evaluate the effectiveness and side effects of prophylactic low-dose bacille Calmette-Guérin (BCG) Tokyo 172 strain. METHODS: We conducted a historical cohort study to compare the clinical usefulness of standard-dose versus low-dose BCG Tokyo 172 strain. A total of 156 patients with superficial bladder cancer (Stage Ta-T1) were historically allocated to either 40 or 80 mg of BCG after transurethral resection. Of the 156 patients, 89 had received standard-dose (80 mg) BCG from 1988 to 2000 and 67 had received low-dose (40 mg) BCG from 1996 to 2005. BCG was instilled into the bladder once a week for 6 consecutive weeks. We excluded 6 patients who did not complete the BCG treatment course. The median follow-up period was 66.9 months (range 2 to 176). RESULTS: Tumor recurrence developed in 21 (32.3%) of 65 patients in the 40-mg group and 29 (34.5%) of 85 patients in the 80-mg group. No significant difference was found in the incidence of tumor recurrence between the two groups (P = 0.6377). Tumor progression was found in 4 (6.2%) of 65 patients in 40-mg group and 9 (10.6%) of 85 patients in the 80-mg group. No significant difference was found in tumor progression between the two groups (P = 0.5010). The overall incidence of side effects and severity of pollakisuria were significantly lower in the 40-mg group than in the 80-mg group (P = 0.012 and P = 0.013, respectively). CONCLUSIONS: The low-dose BCG Tokyo 172 strain achieved identical recurrence-free and progression-free survival as the standard dose with reduced toxicity.

[Persistent Müllerian duct syndrome diagnosed by laparoscopic examination: a case report].

A 2-year-old boy presented for the evaluation of left nonpalpable testis. Laparoscopic examination revealed right migratory testis without any abnormal appearance and a uterine-like structure with an immature gonad in rectovesical fossa. Right spermatic duct merged into the uterine-like structure on the right side. The immature gonad was removed by laparoscopic procedure, while the uterine-like structure was not removed to preserve the right spermatic duct. Right orchidopexy was also performed. Histopathologic diagnosis for the removed gonad was hypoplastic testis. After the chromosomal analysis, 46 XY karyotype, we diagnosed this case as persistent Müllerian duct syndrome. Persistent Müllerian duct syndrome diagnosed by laparoscopic examination is very rare. To the best of our knowledge, this is the third case in Japan.

[Short-term outcome of neoadjuvant gemcitabine-carboplatin therapy for muscle-invasive bladder cancer].

Twenty-three patients with muscle-invasive bladder cancer were treated with combination chemotherapy of gemcitabine and carboplatin. Gemcitabine at a dose of 800 mg/m2 by intravenous infusion for 30 minutes on Days 1, 8 and 15. Carboplatin at an AUC of 4, according to the Calvert formula, was administered by intravenous infusion for 3 hours on Day 2. The treatment was repeated every 21 days without drug-free-weeks for a total of 2 cycles. Six patients achieved a complete response(CR)and 8 patients achieved a partial response(PR). Overall response rate(CR+PR) was 60.8%. In addition, 7 patients achieved stable disease(SD), whereas 2 were found to have progressive disease (PD). Although Grade 3 or 4 leukocytopenia was seen in 10 patients(43.4%), low-grade toxicities of anemia, thrombocytopenia and nausea were seen in several patients, so it was possible to complete the treatment on schedule in all patients. Five SD patients died(4 by cancer and 1 by another cause), 2 PD patients were found to have disease progression, and 16 patients were alive without recurrence with a mean follow-up period of 12.6 months(range: 8-19).

[Adenocarcinoma of the ileal segment 40 years after ileocystoplasty: a case report].

We reported a case of ileal segment adenocarcinoma arising in the augmented bladder 40 years after the operation. The patient was a 57-year-old man who underwent ileocystoplasty (Goodwin method) for contracted bladder due to tubercurosis in 1962. He was referred to our clinic for examination of gross hematuria. Cystoscopy revealed a tumor on the ileal segment of the augmented bladder. He underwent resection of the ileal segment and ureterocutaneostomy. The pathological diagnosis was poorly differentiated adenocarcinoma in the ileal segment. He died of the disease 6 months after the operation.

Experience and functional outcome of modified ileal neobladder in 95 patients.

AIMS: We took advantage of the Goodwin method to develop a modified ileal neobladder. We present the operation procedure and assessed the functional results. METHODS: From April 1997 and May 2005, 95 patients (75 men and 20 women), mean age 64.6 years (range: 36-80 years) underwent orthotopic ileal neobladder replacement with application of the Goodwin method. The Le Duc technique was used for antireflux procedure. However, for the last 35 patients, antireflux procedure was not carried out. The median follow-up period was 37 months (range: 3-98 months). We reviewed the surgical outcome and complications. Continent status and urodynamic profile were also measured. RESULTS: The mean operation time for the neobladder formation was 130 mins (range: 65-285 mins). There were no perioperative deaths. Leakage from the ileourethral anastomosis leak was found in four patients (4.2%), wound infection in nine patients (9.5%), ileal anastomosis leak in two patients (2.1%) and paralytic ileus in two patients. No hydronephrosis, neobladder-ureteral reflux or deterioration of renal function was seen. The maximum neobladder pressure was 21 +/- 13 cm (mean +/- SD) at 6 months and 12 +/- 11 cm at 12 months after surgery. The neobladder capacity was 293 +/- 118 mL at 6 months and 312 +/- 85 mL at 12 months after surgery. Of the 95 patients, 87 (91.6%) maintained complete dryness day and night. CONCLUSIONS: These results suggest that the present orthotopic ileal neobladder is simple to be carried out and achieves acceptable voiding function. Longer observation for neobladder and upper urinary tract function is necessary.

Infrequent mutation of APC, AXIN1, and GSK3B in human pituitary adenomas with abnormal accumulation of CTNNB1.

We analyzed mutation of the APC, AXIN1, and GSK3genes in 14 pituitary adenomas with abnormal nuclear accumulations of CTNNB1. These tumors did not harbor mutation of the CTNNB1 gene. The genes analyzed encode proteins associated with ubiquitin-mediated degradation of CTNNB1. Although the regions encoding functional domains of these protein products were analyzed, no significant genetic alterations were found. Furthermore, the antibody for the C-terminus of APC detected normal expression of the APC protein in these pituitary adenomas. Our present results imply that an unknown mechanism(s) accelerates the accumulation of CTNNB1 that plays an important role in the pathogenesis of human pituitary adenomas. However, the possibility that mutation of regions outside of our survey or epigenetic mechanism play an important role cannot be excluded.

Gemcitabine plus carboplatin; and gemcitabine, docetaxel, and carboplatin combined chemotherapy regimens in patients with metastatic urothelial carcinoma previously treated with a platinum-based regimen: preliminary report.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of two combined chemotherapy regimens in the treatment of previously treated metastatic urothelial carcinoma: gemcitabine plus carboplatin (GC), and gemcitabine, docetaxel, and carboplatin (GDC). METHODS: Sixteen patients with metastatic urothelial cancer, previously treated with a platinum-based regimen, were studied. GC (gemcitabine 750 mg/m(2), on days 1, 8, and 15; carboplatin 200 mg/m(2), on day 2) was administered every 28 days to 15 patients. GDC (gemcitabine 750 mg/m(2), on days 1 and 8; docetaxel 50 mg/m(2), on day 1; carboplatin 200 mg/m(2) on day 1) was administered every 21 days to 9 patients. Eight of the 9 GDC-treated patients had earlier been treated with GC and had become refractory. RESULTS: With the GC therapy, 7 of the 15 treated patients (47%; 95% confidence interval, 21%-73%) showed an objective response, with 3 achieving a clinical complete response (CR) and 4 a partial response (PR). With the GDC therapy, 6 of the 9 treated patients (67%; 95% confidence interval, 29%-92%) showed an objective response, with 1 achieving CR and 5, PR. Five of the 8 (63%) GC-refractory patients responded to GDC therapy. The median duration of response was 4 months (range, 2-10+ months) on GC therapy, and 3 months (range, 3-5 months) on GDC therapy. Toxicities associated with GC were less than those with GDC. CONCLUSION: GC was effective for refractory metastatic urothelial cancer, and GDC was effective for GC-refractory cancer. The aim of this study was to evaluate the efficacy and safety of two combined chemotherapy regimens in the treatment of previously treated metastatic urothelial carcinoma: gemcitabine plus carboplatin (GC), and gemcitabine, docetaxel, and carboplatin (GDC).

[A case of schwannoma in psoas muscle].

We report a case of schwannoma in psoas muscle, difficult to make a preoperative differential diagnosis from multilocular renal cyst in a 44-year-old woman. She complained of epigastric discomfort, and abdominal computerized tomography revealed a left multi-cystic renal tumor. Drip infusion pyelography showed the tumor displacing the left kidney superiorly, and pushing the left ureter medially. Magnetic resonance imaging demonstrated that the tumor structure was multilocular. At the operation, the tumor was observed in psoas muscle and was revealed as schwannoma in microscopic findings.

Clinical significance of ST3Gal IV expression in human renal cell carcinoma.

Alteration of sialyltransferase expression has been implicated in carcinogenesis. Out of sialyltransferases cloned to date, we focused on ST3Gal IV expression in human renal cell carcinoma (RCC). Levels of ST3Gal IV mRNA were examined in human RCC in comparison with non-tumor kidney. ST3Gal IV cDNA obtained by polymerase chain reaction from cDNA library of human RCC cell line ACHN was identical to STZ in nucleotide sequence. Northern blot analysis was performed for 24 non-tumor kidney and 25 primary RCC tissues, and 5 metastases. ST3Gal IV mRNA level was decreased in 16 cases of 22 primary RCC tissues compared to 21 non-tumor kidney tissues. The mRNA level was low in 4 and equivocal in one, of 5 metastases. The 6 cases that possessed almost the same levels of ST3Gal IV mRNA in primary tumor tissues as those in non-tumor kidneys showed favorable prognoses, as assessed by Kaplan-Meier curve. These results indicate that down-regulation of ST3Gal IV mRNA may be one of the factors associated with the malignant progression of human RCC.