Residual contrast medium in the cortex of the kidney around an infected renal cyst on CT: case report.

We present a case of a patient with an infected renal cyst. Delayed computed tomography showed residual contrast medium in the cortex of the kidney around it. Delayed computed tomography might be useful to identify an infected renal cyst.

[Prognostic significance of carcinoma in situ and epithelial dysplasia accompanying bladder cancers].

PURPOSE: We determined whether patients with bladder cancers accompanied by carcinoma in situ (CIS) or epithelial dysplasia carry a poor prognosis. MATERIALS AND METHODS: The resected bladders from 57 patients with a bladder cancer were step-sectioned. The stained specimens underwent microscopic examination and the extent of CIS and epithelial dysplasia was mapped out. The 57 patients were followed up for 5 to 10 years and the cumulative survival rates were calculated. RESULTS: Gross tumors were accompanied by CIS in 29 (51%) patients and by epithelial dysplasia in 52 (91%) patients. The survival rates did not differ significantly between the presence and absence of the accompanying mucosal lesions. However, the cancer specific survival rates were higher in patients with accompanying CIS located away from the gross tumor than in patients with CIS located adjacent to the gross tumor (p = 0.04). In patients with a non-papillary bladder cancer the survival rates tended to be higher when accompanying epithelial dysplasia accounted for over 3% of the whole mucosal area than when it accounted for less than 3% (p = 0.09). CONCLUSIONS: These results suggest that the presence of accompanying CIS or Epithelial dysplasia does not indicated a poor prognosis, and may indicate a favorable prognosis in patients with a non-papillary bladder cancer.

[Results of curative or non-curative nephrectomy for renal cell carcinoma invading adjacent organs].

We reviewed 12 patients who had undergone curative or non-curative nephrectomy for renal cell carcinoma invading adjacent organs (stage T4). 83 patients with renal cell carcinoma confined within the perirenal fascia (T1-T3) who had undergone nephrectomy served as controls. Of the 12 patients with T4 tumor 6 had undergone simultaneous excision of involved adjacent organs (hemicolectomy in 4, resection of the tail of pancreas in 5, splenectomy in 2). At operation 6 patients with T4 tumor had distant metastasis, 3 had fixed lymph node metastases, and 4 had tumor extension into the main renal vein or vena cava. Although T4 tumor had distant or fixed lymph node metastasis more frequently than T1-T3 tumors, the incidence of gross tumor thrombus showed no such difference between T3 and T4 tumors. Postoperative follow-up of patients with T4 tumor showed that local recurrence developed within 9 months in 3 of 5 patients who had undergone curative excision, new distant metastasis developed within 6 months in 5 patients, 1 patient died of acute renal failure in the early convalescence, 10 patients died of the disease within 12 months and 1 died of the disease in 31 months. Pathological examination showed that T4 tumors tended to be classified as grade 3, to extend in an infiltrating fashion and to have a sarcomatoid structure. Patients who had a tumor where these three histological features were dominant died to tumor within 3 months after nephrectomy. These results indicate that curative excision of T4 renal cell carcinoma is not only difficult, but frequently associated with early local recurrence and new distant metastasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculous rectourethral fistula.

A rare case of tuberculous rectourethral fistula is reported. The fistula developed as a sequel of prostatic tuberculosis and was successfully repaired by the method of omental interposition.

[Clinical effect of terodiline hydrochloride on nervous pollakisuria or irritative bladder].

The clinical effect of terodiline hydrochloride (TD-758) was studied in 95 patients with nervous pollakisuria or irritative bladder. TD-758 was given per os randomly at a dose of 24 mg or 12 mg once a day for 4 weeks. The symptoms such as urinary frequency, urinary incontinence and sense of residual urine were improved in 74% of the patients taking 24 mg, and in 51% of the patients taking 12 mg. The difference was statistically significant. Side effects such as dry mouth, constipation and heart burn were observed in 15% of the patients in each group and were not serious. The results of this study indicate that TD-758 is useful for these patients and its optimal dosage is 24 mg once a day.

Chemical pericystitis: a rare complication of intravesical doxorubicin.

We report a rare instance of chemical pericystitis in a 60-year-old man who had undergone transurethral resection of a bladder tumor and subsequent intravesical instillation of doxorubicin. The patient had a high fever lasting for 18 days, lower abdominal pain and mild hydronephrosis. Extravasation of doxorubicin through the resected and thinned region of the bladder wall seemed to be responsible for this complication. The lesion improved spontaneously without any sequela.

Treatment of bladder carcinoma in patients more than 80 years old.

We reviewed 26 patients more than 80 years old with bladder carcinoma to determine if an active surgical policy is justified. Ten patients with superficial carcinoma were treated with transurethral resection; none died of cancer and half have survived 5 years. Of 16 patients with invasive carcinoma 9 underwent total cystectomy with urinary diversion and 2 underwent partial cystectomy. There was no operative mortality. Postoperative complications were not serious. Five of the 9 patients who underwent total cystectomy are alive, with a mean survival of 35 months. The 4-year crude survival rate was 50 per cent. Both patients who underwent partial cystectomy died within 2 years. One patient treated with radiotherapy alone and 1 without any treatment have survived 2 years. These results suggest that contrary to the general tendency towards conservative treatment, a curative operation is worth attempting in elderly patients with bladder carcinoma.

Coexistence of aldosteronoma and pheochromocytoma in an adrenal gland.

An extremely rare case is reported in which aldosteronoma and pheochromocytoma coexisted in an adrenal gland. Although the patients presented with clinical features of primary aldosteronism, preoperative examination showed an elevation of both plasma aldosterone and urinary catecholamines. Histology of the removed adrenal gland revealed that, concurrently with a round mass of adrenocortical adenoma, the adrenal medulla was totally occupied by the typical structure of pheochromocytoma.