Uretero-appendiceal fistula.

We report a case of uretero-appendiceal fistula. A 63-year-old woman was admitted to our hospital with high grade fever and loss of 5 kg of body weight over 6 months. Pyonephrosis was diagnosed. A retrograde ureterogram and barium enema showed a connection between cecum and ureter. Right nephroureterectomy and right hemicolectomy were carried out. The final diagnosis was uretero-appendiceal fistula.

Image-guided radiofrequency ablation for adrenocortical adenoma with Cushing syndrome: outcomes after mean follow-up of 33 months.

OBJECTIVES: To evaluate the feasibility, safety, and therapeutic effects of image-guided radiofrequency (RF) ablation used for the treatment of adrenocortical adenoma with Cushing syndrome. METHODS: From February 2003 to May 2005, 4 consecutive patients with adrenocortical adenoma and Cushing syndrome received percutaneous RF ablation. All tumors were in the left adrenal gland, with a mean tumor size of 2.7 +/- 0.6 cm (range 2.0 to 3.5). The RF ablation was performed under real-time computed tomography fluoroscopic guidance. Technical success was defined as disappearance of tumor enhancement on contrast-enhanced computed tomography imaging acquired within 1 week after RF ablation. Clinical success was defined as improvement in serum cortisol and adrenocorticotropic hormone values and symptoms at the end of follow-up. RESULTS: Tumor enhancement disappeared after initial RF ablation in 3 of 4 patients (technical success rate 75%). The fourth patient underwent a repeat RF ablation session 3 years later, resulting in eradication of tumor enhancement. Both the serum cortisol and adrenocorticotropic hormone levels returned to normal and the symptoms related to Cushing syndrome had disappeared at the end of follow-up (range 20 to 46 months, mean 33) for a clinical success rate of 100%. All tumors showed involution (2.2 +/- 0.3 cm) at the end of the study. No major complications occurred related to the procedures except for pneumothorax requiring chest tube placement for 3 days. CONCLUSIONS: Using RF ablation for adrenocortical adenoma with Cushing syndrome is a feasible, safe, and promising treatment method in selected patients.

Prevention of growth and metastasis of murine melanoma through enhanced natural-killer cytotoxicity by fatty acid-conjugate of protopanaxatriol.

Ginsenosides, the glycosides of Panax ginseng, are metabolized (deglycosylated) by intestinal bacteria after oral administration. 20(S)-Protopanaxatriol (M4) is the main bacterial metabolite of protopanaxatriol-type ginsenosides and mediates their antitumor effects. To clarify the mechanism of the M4-mediated antitumor effect, the antitumor activity and metabolism of M4 was examined, using the C57BL/6 mice implanted with B16-BL6 melanoma. The chronic oral administration of M4 inhibited the growth of B16-BL6 melanoma at the implanted site. Analyses using TLC, HPLC, MS and NMR suggest that orally administered M4 was absorbed from the small intestine into the mesenteric lymphatics followed by the rapid esterification of M4 with fatty acids and its accumulation in the tissues including the liver and lung. The administration of M4 prior to the intravenous injection of B16-BL6 cells abrogated the enhanced lung metastasis in the mice pretreated with 2-chloroadenosine more effectively than in those pretreated with anti-asialo GM1. The esterified M4 (EM4) did not directly affect tumor growth in vitro, whereas it stimulated splenic NK cells to become cytotoxic to tumor cells. These results indicate that the antitumor activity of M4 is based on the NK cell-mediated tumor lysis enhanced by EM4.