[A CASE OF RENAL CELL CARCINOMA WITH INFERIOR VENA CAVAL TUMOR THROMBUS WHICH THE REDUCTION OF TUMOR IN SPITE OF DRUG DISCONTINUANCE AFTER THE FULMINANT HEPATITIS ONSET WITH THE SUNITNIB].

A 70-year-old man presented with right renal cell carcinoma with inferior vena caval tumor thrombus into the right atrium. CT Scan presented local invasion and lymph node metastasis. We estimated inoperative case, so he was started sunitinib. After 5 month he had general fatigue and admitted to our hospital. He diagnosed serious adverse events of fulminant hepatitis and left ventricular systolic dysfunction and discontinued sunitnib. After drug discontinuance reduction of tumor and tumor thrombus were detected. 7-months later, we showed the increase of tumor and the improvement of the left ventricular systolic dysfunction. We performed right renal nephrectomy and it passes now in 14 months after surgery, but doses not show a recurrence, metastasis.

Giant retroperitoneal liposarcoma.

Liposarcomas are one of the most common soft tissue sarcomas of adulthood. Liposarcomas are remarkable because of their frequently large size. We report a case with an extremely large dedifferentiated liposarcoma that weighed 18 kg. Although it was capsulated and could be excised en bloc, the patient suffered a relapse 9 months later and died 1 year after the operation.

Calcium channel blocker versus angiotensin II receptor blocker in autosomal dominant polycystic kidney disease.

BACKGROUND: Although hypertension is commonly found in patients with autosomal dominant polycystic kidney disease (ADPKD), there is no consensus about which antihypertensive agents are most appropriate. The effects of calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB) on blood pressure and renoprotection were compared in hypertensive patients with ADPKD. METHODS: We randomly assigned 49 participants to CCB amlodipine-based (2.5-10 mg/day) or ARB candesartan-based (2-8 mg/day) regimens. Twenty-five patients (13 males and 12 females) received amlodipine, and 24 patients (13 males and 11 females) received candesartan. This was followed up for 36 months. RESULTS: Baseline characteristics were similar, and blood pressure was well controlled in both groups throughout the study period. Six out of 25 (24.0%) amlodipine and 1 out of 24 (4.2%) candesartan patients were terminated from the protocol due to a twofold increase in serum creatinine and/or decrease in creatinine clearance (Ccr) to half of the baseline. The renal event-free survival rate was significant (p < 0.05, Breslow-Gehan-Wilcoxon test). Serum creatinine was higher in the amlodipine group than in the candesartan group at 24 and 36 months (p < 0.05). The decrease in Ccr at 36 months was larger in the amlodipine group than in the candesartan group (DeltaCcr: -20.9 +/- 13.1 vs. -4.8 +/- 13.8 ml/min, p < 0.01). Urinary protein excretion was significantly lower in the candesartan group than in the amlodipine group at 36 months. Urinary albumin excretion was significantly lower in the candesartan group than in the amlodipine group at 12, 24 and 36 months. CONCLUSIONS: The renoprotective effect of candesartan is considered more favorable than amlodipine in the treatment of ADPKD. This is independent of the antihypertensive effect per se.

Inguinal hernia of seminal vesicle cyst.

Seminal vesicle cysts are uncommon abnormalities in the pelvis. The case of a seminal vesicle cyst that extended through the inguinal canal is reported. A 35-year-old man presented with left inguinal swelling. He was diagnosed with a left inguinal hernia. However, the interpretative diagnosis was a spermatic cord tumor. The operation was changed to tumor resection. The tumor existed along with the vas deferens from part of the parietal peritoneum outside the inguinal tunnel to the deep pelvic space. The cylinder-shaped tumor was 3 cm in diameter and 20 cm long. Pathological examination revealed a seminal vesicle cyst that extended through the inguinal canal. To the best of our knowledge, this is the first case report of a seminal vesicle cyst inguinal hernia.

[The evaluation of urination status and International Prostate Symptom Score following radical prostatectomy].

PURPOSE: We evaluated condition of urination and International Prostate Symptom Score (I-PSS) after radical prostatectomy. PATIENTS AND METHODS: Forty-three men with prostatic cancer underwent radical prostatectomy between October 1993 and October 2002. Mean patients age was 66 years (range 56 to 79) and clinical follow-up averaged 38.6 months (range 3 to 84). Urodynamics studies including uroflowmetry, cystometry and evaluation of I-PSS were performed before and 1, 3, 6, 12 months after the operation. After 12 months these studies were performed every year. The status of postoperative urinary incontinence was based on patients' report. RESULTS: First desire to void, maximum desire to void and maximal flow rate was decrease temporarily after radical prostatectomy. However most patients had normal uroflowmetorogram and normal cystometrogram at 6 months. I-PSS and QOL index was improved during postoperative 12 months. CONCLUSIONS: Postoperatively urodynamics studies was improved from 3 to 6 months, but evaluation of I-PSS and QOL index was improved from 6 to 12 months. The difference was formed to both.

[Traumatic dislocation of the testis: report of five cases].

Five cases of traumatic dislocation of the testis are described. Dislocation of the testis is a rare injury, with only 93 cases having been reported in Japan. Recent reports have revealed an increased number of motor cycle accidents involving teenage patients. Early surgical management is required, since closed reduction is difficult. We discuss its classification, diagnosis and treatment.

[Long-term result of the transcatheter arterial embolization for ruptured renal angiomyolipoma].

PURPOSE: The long-term results were studied in patients who underwent transcatheter arterial embolization (TAE) for the spontaneous rupture of renal angiomyolipoma (AML). MATERIAL AND METHODS: Five cases (1 male, 4 females) who underwent TAE for spontaneous AML rupture between November, 1996 and February 2000 were studied. Spontaneous rupture of AML was diagnosed with CT. TAE were carried out by injection of ethanol and lipiodol and application of either a metal coil or gelform. RESULT: In 4 cases, after performing TAE only one time, the tumor size was reduced and there has been no re-rupture or re-bleeding during the ongoing follow-up. In the other case, an enucleation operation was carried out 11 days after TAE in accordance with the patient's request. DISCUSSION: Recently, there have been a few reports on the long-term effectiveness of TAE, a conservative treatment for renal AML rupture. Our study indicated that TAE might be recommended for patients with renal AML rupture not only for stanching and pre-operative treatment but also for a conservative treatment with regular follow-up.