[A CASE OF TEMPORARY CARDIAC ARREST FOLLOWING SUDDEN FLUCTUATION OF BLOOD PRESSURE AFTER INITIATION OF PNEUMOPERITONEUM IN LAPAROSCOPIC ADRENALECTOMY FOR ADRENAL PHEOCHROMOCYTOMA].

A 75-year-old man was referred to our hospital with a complaint of difficulty swallowing and was diagnosed with left medullary infarction. Computed tomography and magnetic resonance imaging revealed a right adrenal tumor, 4 cm in size, and a left adrenal tumor, 1.6 cm in size. Abnormally high concentrations of serum catecholamine and urinary total metanephrine were also observed. In addition, 131I-MIBG scintigraphy revealed an abnormal accumulation of 131I in both tumors, which comprehensively led to the diagnosis of bilateral pheochromocytoma. Laparoscopic right adrenalectomy was planned first. After initiating pneumoperitoneum, the systolic blood pressure rose to 270 mmHg. Pneumoperitoneum was suspended briefly, and once resumed, the patient's blood pressure dropped gradually and was followed by cardiac arrest. A decision was made to interrupt surgery and start cardiopulmonary resuscitation. Once blood pressure stabilized above 160 mmHg, the patient was transferred to the intensive care unit with intubation. Subsequently, blood pressure was controlled to around 140 mmHg. He was discharged on the eleventh day after surgery without any major complications. Currently, he is being managed with more aggressive antihypertensive drug treatment.

Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Castration-Resistant Prostate Cancer Patients Who Received Cabazitaxel Chemotherapy.

INTRODUCTION AND OBJECTIVES: An elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be associated with a poor prognosis in several cancers. We evaluated the utility of an elevated NLR as a biomarker to predict the prognosis of metastatic castration-resistant prostate cancer (mCRPC) patients treated with cabazitaxel (CBZ). METHODS: We analyzed 47 patients who received CBZ chemotherapy for mCRPC in our institutions. The NLR was calculated using the neutrophil and lymphocyte counts before CBZ chemotherapy. We determined the NLR cut-off value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. A multivariate analysis was performed to investigate the association between the NLR and the prognosis. RESULTS: The median overall survival (OS) after CBZ was 10.0 months (range: 6.3-13.2). The median OS was shorter in patients with a high NLR (≥3.83) than in those with a low NLR (<3.83) (5.8 versus 13.2 months, p = 0.018). In the multivariate analysis, the NLR, patient age, and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.01, p = 0.030; hazard ratio 3.10, p = 0.029; hazard ratio 12.38, p = 0.001, resp.). CONCLUSIONS: NLR might be a useful prognostic biomarker in mCRPC patients treated with CBZ.

[A Case of Squamous Cell Carcinoma in Bladder Diverticulum Producing Granulocyte Colony Stimulating Factor].

We report a rare case of squamous cell carcinoma (SCC) in bladder diverticulum producing granulocyte colony stimulating factor (G-CSF). A 59-year-old man complaining of hematuria and right hip pain was admitted with a large cancer in the bladder diverticulum. His laboratory data showed leukocytosis of 20,100/ µ l (neutrophils : 92%) with an elevated G-CSF of 76. 6 pg/ml in the peripheral blood. After neoadjuvant chemotherapy (gemcitabine and cisplatin), radical cystectomy was performed to normalize serum leukocytosis and G-CSF. Histopathological diagnosis was G-CSF-producing SCC pT4N0. He appeared with left pelvic lymph node metastasis and right pulmonary metastasis 3 months after surgery. Therefore, he was treated with four courses of combination chemotherapy (paclitaxel, ifosfamide and nedaplatin) and radiation therapy at left pelvic lymph node metastasis. Computed tomography after these treatments showed complete response. The patient is alive with no evidence of tumor 16 months after surgery.

Androgen deprivation therapy prevents bladder cancer recurrence.

Although accumulating preclinical evidence indicates the involvement of androgen receptor signals in bladder cancer (BC) development, its clinical relevance remains unclear. We aimed to evaluate the predictive role of androgen deprivation therapy (ADT) in BC recurrence in prostate cancer (PC) patients. We retrospectively reviewed 20,328 patients with PC diagnosed during 1991-2013 and identified 239 (1.2%) men having primary BC. After excluding ineligible patients, 162 patients made up a final cohort. With a median follow-up of 62 months, 38 (50%) of 76 control patients without ADT experienced BC recurrence, while 19 (22%) of 86 did in ADT group. Thus, patients having received ADT for their PC showed a significantly lower risk of BC recurrence (5-year actuarial recurrence-free survival: 76% v 40%; P < 0.001) and also had a significantly smaller number of recurrence episodes (5-year cumulative recurrence: 0.44 v 1.54; P < 0.001), compared to the control patients. A multivariable analysis revealed ADT as an independent prognosticator (hazard ratio, 0.29; 95% confidence interval, 0.17-0.49) for BC recurrence. This is the first clinical study showing that ADT significantly reduces the risk of BC recurrence.

[A case of schwannoma in the renal hilum].

An 80-year-old woman was referred for evaluation and treatment of a left renal mass. An abdominal CT scan showed a 4.6 X 3.7 cm mass in the left kidney. The lesion was slightly enhanced by contrast medium. Since renal cell carcinoma could not be ruled out, radical nephrectomy was performed. The tumor weighed 190 g. Histological examination revealed Antoni A and Antoni B type schwannoma. Schwannoma is a tumor arising from the sheath of the peripheral nerves. The present case is the 6th case of schwannoma arising in the renal hilum reported in the English and Japanese literature.

A case of infective endocarditis after transurethral prostatic resection.

We report a case of infective endocarditis (IE) after transurethral prostatic resection (TUR-P). A 63-year-old man who had underwent TUR-P for benign prostatic hyperplasia. After 40 days of surgery, he developed a fever. A diagnosis of IE was established by cardiography which detected large vegetation at mitral valve. After intravenous antibiotics therapy, he underwent mitral valve replacement surgery.

A Case of Bilateral Adrenal and Pleural Metastases from Prostate Cancer.

Our case was 65 years old. At check-up, a high PSA level of 515 ng/ml was observed, the patient was diagnosed with having clinical stage D prostate cancer and a Maximum Androgen Blockade (MAB therapy) was started. In response to the exacerbated prostate cancer, we started a therapy involving the administration of 8 mg/kg body weight of dexamethasone and 55 mg/m(2) of docetaxel every 3 weeks. After completing 8 courses, an enlargement of the bilateral adrenal tumor was observed, and after completing 12 courses, a pleural tumor was discovered and the PSA level was also increased. The patient was therefore diagnosed with having bilateral adrenal metastasis and pleural metastasis of prostate cancer through diagnostic imaging. So far, there have been no reports of multiple occurrences of prostate cancer in the adrenal glands and the pleura, thus making this case the first such case.

[Bladder stone secondary to migration of an acupuncture needle].

A 61-year-old man who had been suffering from benign prostatic hyperplasia (BPH) for ten years visited our hospital complaining of dysuria and bladder pain. Abdominal X-ray showed a 2 cm calculus containing a needle-like shadow in the pelvis. Transurethral lithotripsy and trunsurethral resection of the prostate (TURP) were done. The calculus was a brown club-shaped bladder stone with the core being a 2 cm needle one side of which was broken. It was supposed to be an acupuncture needle that was retained in his back twenty years ago. This is the first case of a bladder stone secondary to migration of an acupuncture needle.

[Massive residual stones after ESWL for staghorn cystine calculi were completely dissolved by oral administration of alkaline citrate: a case report].

A 62-year-old woman was referred to our hospital for bilateral renal stones. Ultrasonography (US) and computed tomography (CT) revealed bilateral staghorn calculi and atrophic left kidney. She had extracorporeal shock-wave lithotripsy (ESWL) for right renal stone during the first 6 months. However, ESWL was not effective and the patient did not want to continue this treatment. Her stone was composed of cystine. We started oral administration of alkaline citrate. Then massive residual stones were completely dissolved during the next 32 months.

Testosterone administration promotes regeneration of chemically impaired spermatogenesis in rats.

AIM: It has been proposed that gonadotropin-releasing hormone (GnRH) analog administered after testicular damage stimulates the recovery of spermatogenesis. However, GnRH analogs suppress the function of sex accessory organs. In this study, we investigated whether testosterone also stimulates the regeneration of rat spermatogenesis after exposure to busulfan. METHODS: Male Fisher rats were divided into three groups of five each and all rats were treated with busulfan, 25 mg/kg, intraperitoneally at week 0. Group A served as the control. The other two groups received testosterone enanthate, 8 mg/kg, subcutaneous injections at 3 week intervals two times before (group B) or three times after (group C) busulfan. States of spermatogenesis were evaluated by histology and by the number of spermatid nuclei per testis at week 25. RESULTS: The mean percentage of 'recovered' seminiferous tubules plus or minus standard deviation was 10.3 +/- 7.8% in group A and 2.1 +/- 1.2% in group B. In both groups, more than 80% of the tubules remained degenerated. However, testes of group C rats showed an improvement of up to 37.1 +/- 20.5% (P < 0.05). The significant recovery of spermatogenesis was also demonstrated in group C by counting the number of spermatid nuclei per testis ([78.8 +/- 57.5] x 106). However, the count was only (7.6 +/- 13.5) x 106 and (0.52 +/- 1.0) x 106 in group A and B, respectively. CONCLUSIONS: Testosterone administration after severe testicular damage enhanced the regeneration of spermatogenesis in rats. We assumed that supplementary doses of testosterone would be more practical for clinical application than GnRH analogs, because exogenous testosterone maintains androgenicity.

Inguinal metastasis of a bladder mixed carcinoma with predominant adenocarcinoma component.

We report a case of urinary bladder mixed carcinoma with inguinal metastasis. Histological examination of the transurethral resection specimens revealed adenocarcinoma with small foci of squamous and transitional cell carcinomas. A right inguinal metastasis occurred 1 year after radical cystourethrectomy. Chemotherapy and radiotherapy were performed but the metastatic tumor remained unchanged.

Recovery of spermatogenesis by high dose gonadotropin-releasing hormone analogue treatment in rat cryptorchid testis after orchiopexy.

PURPOSE: Cryptorchidism is an adverse condition of spermatogenesis in many mammals. Surgical cryptorchidism in rats lasting more than a few weeks is so detrimental that spermatogenesis cannot be completely recovered even after orchiopexy. We evaluated the efficacy of the high dose gonadotropin-releasing hormone (Gn-RH) agonist leuprorelin acetate on damaged spermatogenesis in rat cryptorchid testes. MATERIALS AND METHODS: Male Fisher rats were divided into 2 groups of 6 each and bilateral cryptorchidism was artificially produced. Five weeks later all rats underwent bilateral orchiopexy. One group served as the control, while the other received Gn-RH agonist injections at orchiopexy and 4 weeks later. The animals were sacrificed 15 weeks after orchiopexy. The weight of the body, testis and epididymis was measured and the histology of spermatogenesis was examined. For statistical analysis the Student t test was applied. RESULTS: Testes in the Gn-RH group rats showed significant recovery of spermatogenesis up to complete spermatozoa formation, while those in control rats remained almost degenerated. The mean incidence of seminiferous tubules with recovered spermatogenesis plus or minus standard deviation was significantly higher in the Gn-RH than in the control group (87.8% +/- 6.0% versus 12.5% +/- 7.7%, p <0.001). CONCLUSIONS: Administering the high dose Gn-RH agonist leuprorelin acetate after orchiopexy greatly enhanced the recovery of spermatogenesis in rats. This finding is in accordance with other recent reports that treatment with Gn-RH analogues promotes the regeneration of once damaged spermatogenesis. On the other hand, these findings may cause one to question supplementation therapy now used in regular practice to boys with cryptorchidism.