Laparoscopic adrenalectomy for pheochromocytoma: a literature review.

Laparoscopic adrenalectomy has become the standard treatment for benign adrenal tumors, providing minimal invasiveness and early recovery. In the case of pheochromocytomas, special attention should be paid perioperatively to prevent excessive hypertension or hypotension. The protocol should include sufficient preoperative medication with alpha 1 blockers, early ligation of the adrenal vein, and minimal handling of the tumor itself. A literature review of 227 laparoscopic adrenalectomies for pheochromocytomas revealed that the perioperative data, including the operative time, blood loss, and hemodynamic status, were similar or slightly better in the laparoscopic procedures as compared to the open procedures, although the convalescence period was significantly shorter in the laparoscopic surgery. The majority of surgeons prefer the transperitoneal approach for pheochromocytomas, although some authors use the retroperitoneal approach successfully. A comparison of the perioperative data from laparoscopic surgeries for pheochromocytomas versus those for other adrenal tumors showed that the former had slightly higher demands to complete the procedure safely. In the treatment of familial pheochromocytoma due to multiple endocrine neoplasia type 2 or von Hippel-Lindau disease, a cortical-sparing adrenalectomy can be safely performed laparoscopically. In conclusion, laparoscopic adrenalectomy is the standard for small pheochromocytomas, with a high success rate when the procedure is performed by experienced surgeons.

[Transperitoneal laparoscopic radical prostatectomy with the Montsouris technique: experience in initial 5 cases].

PURPOSE: In 1998 Guillonneau et al reported feasible and safe technique for laparoscopic radical prostatectomy. Herein we review initial 5 cases with using the Montsouris technique. MATERIALS AND METHODS: Between January and April 2000, 5 patients underwent transperitoneal laparoscopic radical prostatectomy. Clinical stages were T1c in 2, T2a in 1 and T2b in 2 patients. Preoperative PSA levels and Gleason grades in needle biopsies ranged from 7.9 to 39 ng/ml and from 2 to 6, respectively. Under general anesthesia 5 to 6 trocars were introduced and the patient was placed in the exaggerated Trendelenburg position. In 2 patients bilateral obturator lymph nodes were dissected for frozen pathological examination. Antegrade prostatectomy was performed initiating with the transperitoneal dissection of seminal vesicles. A watertight vesicourethral anastomosis was made with 8 to 10 interrupted sutures. RESULTS: Operating time and blood loss ranged from 505 to 925 minutes and from 100 to 700 gm, respectively. There were no intraoperative complications and one postoperative complication of prolonged urinary leakage, which was spontaneously closed. In other 4 patients Foley catheters were removed on postoperative day 6 to 10. CONCLUSIONS: Laparoscopic radical prostatectomy provides better visualization, inducing meticulous surgical procedures and less blood loss. More sophisticated maneuver would be required in dissection between the prostate and the bladder neck.

[Study on platinum concentration in internal iliac venous blood after iliac artery cisplatin infusion for invasive bladder cancer].

We evaluated the usefulness of internal iliac artery infusion of cisplatin (CDDP) in the M-VAC therapy for bladder cancer. CDDP (average 72 mg) was administered into the internal iliac artery with an infusion time of 15 minutes in 8 cases of bladder cancers. After the end of CDDP intra-arterial injection, we measured the total and free platinum (Pt) levels in the internal iliac venous blood and systemic venous blood. Both total and free platinum levels in the internal iliac venous blood were about 4 times higher than those in the systemic vein. No significant difference was found in total or free platinum level in the systemic blood between the intra-arterial and intra-venous infusion methods. Intra-arterial CDDP therapy is effective in the treatment of the local tumor and systemic micrometastasis.

New variant translocation (8;20)(q22;q13) in acute myelocytic leukemia.

A new variant translocation, (8;20)(q22;q13) in a patient with acute myelocytic leukemia (AML) M2 is reported. As far as we know, this is the second case of the t(8;20) in de novo AML. Further studies are required to clarify the key event leading to the development of AML-M2.

[MRI findings in a testicular epidermoid cyst: a case report].

A 21-year-old man was admitted with a painless mass in the left testis. Physical examination revealed a firm, small-finger sized, mass lesion with a smooth surface in the left testis. The ultrasonographic appearance was a hypoechoic lesion with an echogenic rim in the left testis. Magnetic resonance imaging (MRI) findings showed the echogenic rim to be a low-signal zone on both T1 and T2-weighted images. The center, on T2-weighted images, had a low signal intensity, with peripheral high signal intensity. Under a preoperative diagnosis of epidermoid cyst, the mass was resected surgically with preservation of the testis. Histopathological diagnosis confirmed an epidermoid cyst. Preoperative ultrasonographic and MRI findings suggested a benign lesion, thus permitting preservation of the testis.

[Somatic mosaicism of p(CTG)n expansion in a case of myotonic dystrophy with parotid tumor].

Myotonic dystrophy (MD) is an autosomal dominant systemic disorder with an unstable expansion of the CTG triplet repeat in the 3'-untranslated region of the gene encoding myotonine protein kinase (DMPK) which maps to chromosome 19q13.3. Somatic mosaicism of CTG repeats in MD has been reported; and it has been observed that CTG repeats in tumor tissues associated with MD are more expanded than the other tissues. It is not rare that parotid tumors are found in patients with MD. We performed Southern blot analysis for tissues from the parotid tumor, the normal parotid gland, the skeletal muscles, and the leukocyte from a 60-year-old patient with MD. CTG repeat was most expanded in the parotid tumor, and the normal parotid gland had longer expansion of CTG repeat than the skeletal muscles. The leukocyte had the shortest expansion of CTG repeat. The expansion of CTG repeat in the parotid tumor may be related to active cell division and may underlie the occurrence of tumors in MD.

[Clinical statistics on in-patients and operations during a 20-year period (1975-1994) at Department of Urology, Kansai Medical University].

The patients, diseases and operations experienced between 1975 and 1994 in our department were statistically analyzed. The numbers of in-patients and operations have been increasing since 1977. During these 20 years, endoscopic surgery has replaced many open surgical procedures. The introduction of extracorporeal shock wave lithotripsy has dramatically changed the therapeutic modality for urolithiasis, and decreased of the necessity of open surgery.

[BUN, Bence Jones protein, and chromosomal aberrations predict survival in multiple myeloma].

The prognostic significance of of some clinical features in 41 patients with multiple myeloma (including 2 patients with plasma cell leukemia) from our institution was analyzed. Out of 14 variables isolated from the univariate analysis (P < 0.05), only three (BUN, Bence Jones protein, and chromosomal aberrations) were significant in the multivariate model (P < 0.05). Derived from these three variables, three subpopulations of patients were identified. The first group included 20 patients with a low risk of death and their median survival has not been reached. In particular, no one died during the first 60 months in this group. The second group also included 14 patients with an intermediate risk of death and a median survival of 49.2 months. The third group comprised seven patients with a high risk of death during 24 months after diagnosis and a median survival of 31.6 months (P < 0.0001). Finally, Durie & Salmon's myeloma staging system was demonstrated in the present series, and it showed prognostic validity for each stage (P < 0.0222). Compared with Durie & Salmon's staging system, our prognostic model for multiple myeloma was more useful to predict prognosis when applied to the present series.

[Clinical characteristics of chronic sinusitis with different lower respiratory tract diseases].

We determined the clinical characteristics of chronic sinusitis in patients with different lower respiratory tract diseases. Sinusitis was divided into three groups. The first group was sinusitis with bronchial asthma. The second group was sinusitis with chronic bronchitis, bronchiectasis or diffuse panbronchiolitis. This type of sinusitis is generally called sinobronchial syndrome (SBS). The third group was sinusitis without lower respiratory tract disease. Because the pathogenesis of these lower respiratory tract diseases differs with the diseases, the pathogenesis of sinusitis accompanied by these lower respiratory tract diseases also may be different. Clinical and laboratory examinations used in this study were rhinoscopy, X-ray examination of the paranasal sinuses, cytological study of nasal secretion and the saccharin test for the muco-ciliary function of the nasal mucosa. By rhinoscopic examination, no difference was found in the size of the nasal polyp among three groups. The results of other examinations were as follows. X-ray examination: Involvement of the ethmoid sinuses was greater than that of the maxillary sinuses in the patients with sinusitis with bronchial asthma. In contrast, involvement of the maxillary sinuses in SBS patients was greater than that of the ethmoid sinuses. Cytology of nasal secretion: Dominant inflammatory cells in the patients with sinusitis with bronchial asthma were eosinophils, while neutrophil were more frequently found in the SBS patients. Saccharin test: Most of the patients with bronchial asthma showed normal responses. In the SBS patients, however, only a few patients showed a normal response and the others showed prolonged responses. Clinical characteristics of the patients with sinusitis without lower respiratory diseases were more similar to those of the SBS patients. In conclusion, there were distinct differences in these clinical characteristics between sinusitis with bronchial asthma and SBS. These results suggest that the pathogenesis or the inflammatory process of sinusitis is heterogeneous and whether the inflammation is allergic or not may be important.

[Clinical efficacy of the Porges Urospiral, a reversible intraprostatic spiral stent, in patients with benign prostatic hypertrophy].

The Porges Urospiral, a urethral spiral stent made of stainless steel wire, is designed for patients with benign prostatic hypertrophy. To evaluate the safety and efficacy of the stent, a prospective uncontrolled study was performed on 60 patients who complained of urinary retention (48 patients) or severe dysuria (12 patients) due to prostatic hypertrophy. Four patients had neurogenic disorders resulting in bladder dysfunction. The average age of the patients was 77.4 years old, ranging from 61 to 91 years old. In 48 patients, the stent was used instead of transurethral resection of the prostate (TUR-P) because of the patients poor general conditions, while in 12 patients the stent was transiently used until TUR-P. Subjective symptoms, according to an original scoring system, and objective signs, uroflowmetry measurements and residual urine volume, before and 3 months after stent insertion were compared. The stent was indwelt for more than 3 months in 40 of the 57 patients in whom the stent could be inserted. Out of 37 evaluable patients, subjective symptoms improved in all the patients and objective symptoms improved in 26 patients (70.3%). Complications included urinary incontinence, urination pain, urethral pain, gross hematuria or migration of the stent. Although these complications disappeared in a few days after the insertion of the stent in a majority of the patients, the stent was removed in 17 patients due to complications within 3 months after insertion. The overall clinical efficacy of this stent was 56% in 50 evaluable patients who had no neurogenic disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunohistopathological properties of cytoskeletal proteins and extracellular matrix components in pleomorphic adenomas of salivary glands].

Twenty-five pleomorphic adenomas and 10 normal salivary glands were immunohistochemically studied with respect to cytoskeletal proteins and extracellular matrix components to observe the relationship between these components and the differentiation of tumor cells in pleomorphic adenomas. For immunohistochemical observation, keratin (AE1), vimentin (V9), alpha-smooth muscle actin (1A4) and type IV collagen (JK-199) were studied by means of monoclonal antibodies, and laminin (LM) and fibronectin (FN) were analysed with polyclonal antibodies. AE1 was localized in inner tubular cells, and 1A4 was identified in spindle and leiomyomatous cells. These observations may provide evidence of differentiation into ductal epithelia and myoepithelial cells, respectively. Positive staining for V9 in cuboidal cells suggests dedifferentiation. The extracellular matrix components, JK-199, LM and FN, were localized in surrounding areas of cells stained by V9 and/or 1A4. This suggests that expression of these cytoskeletal proteins and extracellular matrix components may affect each other, and ther by contribute to cellular differentiation and production of extracellular matrix.

Gene amplification and overexpression of EGF receptor in squamous cell carcinomas of the head and neck.

Tumours of the head and neck were examined for gene amplification and expression of the epidermal growth factor (EGF) receptor by Southern blot and Western blot analyses. The EGF receptor gene was found to be amplified in four (19%) of 21 squamous cell carcinomas. The EGF receptor was overexpressed in eight (53%) of 15 squamous cell carcinomas examined, including all four tumours showing gene amplification. No amplification or overexpression of the EGF receptor gene was detected in any of nine malignant or eight benign tumours of other types of the head and neck. The tumours showing amplification and/or overexpression of the EGF receptor gene (8/15) were all identified histologically as well differentiated squamous cell carcinomas, whereas none of the histologically less differentiated squamous cell carcinomas (0/9) showed amplification and/or overexpression of the EGF receptor gene. Within our sample set, no correlation was evident between amplification and/or overexpression and the clinical stage or tumour site. Our results support the possible involvement of gene amplification and overexpression of the EGF receptor in a subclass of squamous cell carcinomas of the head and neck.