Observation of perpendicular exchange bias in an Ir-doped Fe2O3/Co ultrathin film system.

In this work, we investigated the temperature dependence of interface exchange coupling in an Ir-doped Fe2O3/Co system with variations in the Ir-Fe2O3 thickness. Low-temperature perpendicular exchange bias was observed in the samples with an Ir-Fe2O3 thickness of 5 nm or less, when it cooled from 360 K in an external magnetic field of 1 T perpendicular to the sample surface. For 5 nm-thick Ir-Fe2O3, a maximum exchange bias value of 1200 Oe was obtained at 200 K. This is the first report on perpendicular exchange bias of an Fe2O3 thin film coupled with a ferromagnet. Enhancements to the Morin temperature and the magnetic anisotropy of Fe2O3 caused by lattice strain, Ir doping, and the finite-size scaling effect, as well as the high quality (good crystal orientation, small roughness, etc.) of the Fe2O3 film fabricated by our process, are considered to be mostly responsible for the perpendicular exchange bias obtained.

Primary transitional cell carcinoma of prostate: case with lymph node metastasis eradicated by neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) therapy.

A case of transitional cell carcinoma of the periurethral prostatic ducts received neoadjuvant chemotherapy consisting of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC), which eradicated pelvic lymph node metastasis, followed by cystoprostatectomy. M-VAC therapy may be indicated for metastatic transitional cell carcinoma of the periurethral prostatic ducts.

Combination chemotherapy for advanced urothelial-tract carcinoma.

Between December 1982 and November 1990, 31 patients with advanced urothelial carcinoma were treated with one of two combination chemotherapy regimens. A total of 20 patients were treated with 3 mg/m2 mitomycin C and 300 mg/m2 cyclophosphamide given intravenously every 10-14 days and with 180 mg/m2 5-fluorouracil (5-FU) given intravenously every day for as long as possible (CF-Mito regimen). After the patient had been discharged from the hospital, the same treatment with CF-Mito was performed except that 180 mg/m2 5-FU was replaced by 400 mg/m2 UFT (a mixture of tegafur and uracil) given orally. A total of 11 patients whose tumor had relapsed during the first-line treatment were given 60 mg/m2 cisplatin, 40 mg/m2 Adriamycin, and 40 mg/m2 methotrexate intravenously every 28 days (PAM regimen). In all, 20 patients received 4-44 (mean, 9.7) courses of CF-Mito over a period of 1.5-24 (mean, 5.3) months. The results obtained in these 20 patients with evaluable lesions included no complete remission (CR), 4 partial remissions (PRs), 9 cases of stable disease (SD), and 7 cases of progressive disease (PD). The PR duration was 1.5-22 (mean, 7.5) months. The side effects encountered in this group included anorexia, nausea, vomiting, myelosuppression, diarrhea, stomatitis, liver damage, and heart failure. In all, 11 patients received 3-7 (mean, 4.1) courses of PAM over a period of 3-14.5 (mean, 5.2) months. All 11 patients had evaluable lesions, and their responses included no CR, 5 PRs, 3 cases of SD, and 3 cases of PD. The PR duration was 1-3 (mean, 1.6) months. The side effects encountered in this group included anorexia, nausea, vomiting, myelosuppression, heart failure, and hair loss.

Laparoscopic adrenalectomy via the retroperitoneal approach: first five cases.

Between February and November 1994, we performed laparoscopic retroperitoneal adrenalectomy in five patients with benign adrenal tumors to confirm the efficacy of this operation. Using digital dissection and a balloon, we created a working space in the retroperitoneal cavity before we dissected the adrenal gland and removed it under laparoscopic observation. The adrenal glands of all five patients were removed without any complications. The mean operative time was 3.4 hours, and the mean estimated blood loss was 148 mL. The average postoperative hospital stay was 10 days, and the average full recovery time was 19 days. We concluded that the retroperitoneal approach is an advantageous and safe procedure in the laparoscopic removal of the adrenal gland with benign tumor.

[Studies on the pathogenesis of idiopathic male infertility by testicular biopsy].

We have been studying the cause of idiopathic male infertility by means of testicular biopsy, and already have made several reports. This is a summary of these reports and a presentation of our concept for hypothetic pathogenesis of idiopathic infertile testes. Testicular biopsies were performed by Charny's accepted technique and tissues examined by light microscopic, histochemical, and transmission and scanning electron microscopic procedures. Also the circulatory sexual hormones; follicle stimulating hormone, luteinizing hormone, and testosterone of all patients were measured. The primary pathogenetic changes occur in the seminiferous tubular walls which are thickened by increase in immature collagen fibers and lamellation of seminiferous basement membrane, and they are followed by increase of follicle stimulating hormone. These seminiferous tubular changes occur discontinuously, so the idiopathic infertile seminiferous tubules resemble a rope strangulated in various places, or a tail-like rope gradually becoming thinner. Also, activated mast cells increase around the strangulated places. Thus, spermatogenesis in strangulated tubular parts decreases because of the nutritional disturbance caused by thickened tubular walls, and the strangulation of tubules interferes with the travel of sperms in the seminiferous tubules by interrupted seminiferous tubular peristalsis. Sloughing or disorganization in the infertile seminiferous tubules can be observed. In the infertile testes, Leydig cells generally increase with the elevation in the level of luteinizing hormone, but serum testosterone does not increase. And this normal value of serum testosterone is statistically found to be caused by the degradation in the quality of Leydig cells in idiopathic infertile testes. Also, galactose deficiency in glycoproteins of idiopathic infertile testicular tissue is reported.

[Indication of neobladder replacement in patients undergoing radical cystectomy for bladder cancer].

Neobladder replacement has become an important procedure in the patient undergoing radical cystectomy for invasive bladder cancer. It yields postoperatively excellent quality of life in these patients. The indications of the patients selection have not been established, since long-term clinical results have not been presented and some issues such as urethral recurrence of the original disease, growth of the cancer from the neobladder made of the gastrointestinal tract and influences arising from orthotopic micturition are still unclear. We reviewed the reports describing neobladder replacement in the patients undergoing cystectomy for the bladder cancer. At present the criteria of patients selection described by most authors can be summarized as follows, (1) male patients, (2) patients having an available gastrointestinal tract for reconstructing the neobladder, (3) patients having a good renal function and liver function and could tolerate for the surgery and (4) patients with no evidence of disease in their urethra and prostate (direct invasion of the disease). As to carcinoma in situ within the bladder, some authors included their indication and the others contraindication.

[A case of leiomyosarcoma of the kidney].

A case of renal leiomyosarcoma seen in a 65-year-old man is reported. On November 15, 1985, he complained of right flank pain and high fever. On right renal angiography and computed tomography showed a mass on lower pole of the right kidney. On December 10, 1985, the patient underwent right radical nephrectomy. The histological diagnosis was leiomyosarcoma probably originating from the right renal capsule. Forty-six cases of renal leiomyosarcoma, including this case, in the Japanese literature have been reviewed and are discussed.

[Malignant pheochromocytoma presenting as an acute abdomen: a case report].

A case of right adrenal malignant pheochromocytoma was reported. The patient was a 16-year-old boy who complained of severe right side abdominal pain due to spontaneous hemorrhage into the retroperitoneal space. Right adrenalectomy was performed on Feb. 22, 1988 but the preoperative high serous catecholamine level did not drop to the normal level. Postoperatively bone and liver metastasis were detected by a 131I-MIBG scan. He was treated with a combination chemotherapeutic regimen consisting of cyclophosphamide, vincristine and dacarbazine in 2 repeated cycles but there was no effect. He died 5 months after the operation.

[Bladder replacement by entero-cystoplasty after radical cystectomy for bladder cancer--the urethral Kock pouch].

From September 1989 to March 1990, 6 male patients with invasive bladder cancer, 49 to 70 years old in age, underwent bladder replacement with the ileum (the urethral Kock pouch) after radical cystectomy. Follow up ranged between 3 and 9 months. Urodynamic evaluation showed the ileal bladder to be a low pressure reservoir with a capacity that increased to more than 250 ml. The ileal bladder was emptied by straining without significant residual urine in all patients except one who was performing intermittent self-catheterization. All patients were continent in the daytime. However, all patients required pads at night because of occasional loss of a little urine. Excretory urograms revealed excellent upper tract function. The procedure is suitable whenever the urethra can be preserved after cystectomy for cancer.

Retroperitoneal schwannoma mimicking lymph node metastasis of seminoma.

We report a case of retroperitoneal schwannoma mimicking lymph node metastasis. A 32-year-old man presented with an intrascrotal mass, and underwent radical orchiectomy. Histological examination revealed a typical seminoma of the testis. Systemic work-up for staging demonstrated a retroperitoneal mass, which was located in the supra-hilar inter-aortocaval region. Under the diagnosis of retroperitoneal metastasis of the seminoma, he underwent three courses of cisplatin, vinblastine, and bleomycin (PVB) therapy. Persistence of the tumor after the chemotherapy led to retroperitoneal lymphadenectomy, histological examination then revealing a benign schwannoma. The location of the tumor and its unresponsiveness to chemotherapy might be useful indicators for differentiating lymph node metastasis of seminoma from primary tumors of other origin.

[A case of testicular tumor arising in the undescended testis].

A 42-year-old man with testicular tumor arising in the left undescended testis is reported. The patient had bilateral cryptorchidism and was admitted to our clinic on March 20, 1989, complaining of a mass in the lower abdomen. Colography indicated complete obstruction at the sigmoid colon, and computed tomography showed a larger mass in the lower abdomen and paraaortic lymph node swelling, as well as left hydronephrosis. We suspected that a testicular tumor had arisen in the undescended testis, and ileus was caused by the tumor mass. Since the patient was in a poor condition from preexisting ileus, chemotherapy consisting of cisplatin, bleomycin and vinblastine (PVB regimen) was immediately started without confirming the histology. After two courses of PVB regimen, bilateral orchiectomy, retroperitoneal lymphadenectomy, and left nephrectomy were performed. Pathological examination of the testis and resected lymph nodes revealed no residual tumor cells, and we could not identify the original histology. Additionally, two courses of chemotherapy were performed after surgery. The patient is well without evidence of disease one year and ten months after surgery.

[A study of postoperative adjuvant chemotherapy of advanced urinary epithelial cancer].

The effect of postoperative adjuvant chemotherapy was studied in 22 cases of advanced urinary epithelial cancer. Vincristine, mitomycin C and bleomycin (VMB) was administered in combination to 9 prophase cases from December, 1980 to March, 1982 and cis-dichlorodiamine platinum, peplomycin and mitomycin C (PPM) in combination to 13 anaphase cases from April, 1982 to November, 1984. The site was renal pelvic cancer in 3 cases, cancer of the ureter in 3 cases, cancer of the bladder in 13 cases, cancer of the pelvis, ureter, and bladder in 1 case, and recurrence of pelvic cancer following bladder cancer in 2 cases. The degree of invasion was pTa in 2 cases, pT1 in 1 case, pT2 in 1 case, pT3 in 11 cases and pT4 in 5 cases. Lymph node metastasis had occurred in 9 cases, no metastasis in 8 cases and it was unclear in the remaining 6 cases. The mean observation period was 16.5 months; 10 patients were alive without any tumors, one patient was alive with a tumor, 11 patients died of cancer, and one patient died intercurrently. The mean postoperative survival period in the mortality cases was 14.5 months. According to the classified type of chemotherapy received, there were 3 out of 9 cases (33.3%) who survived without tumors after receiving VMP and 7 out of 13 cases (53.8%) in the PPM group who survived without tumors. Although a simple comparison cannot be made, it appears that PPM therapy is superior. No severe side-effects were observed.

[Recurrence of transitional cell carcinoma in the left pelvis and ureter, and ileal conduit after total cystectomy: a case report].

A 63-year-old male with transitional cell carcinoma of the bladder underwent total cystectomy. Five years later sequential excretory urography and urinary cytologic examination revealed tumor recurrence in the left pelvis and ureter; left nephroureterectomy was performed in July, 1984. In December, 1985, he complained of macrohematuria and urinary cytology was positive. Ileal conduitgraphy showed filling defects at the bilateral uretero-ileal anastomosis, where two papillary lesions were disclosed by endoscopic examination. In January, 1986, total extirpation of the ileal conduit and reconstruction of a new ileal conduit was performed. Macroscopically the two lesions were found to be a papillary tumor at left uretero-ileal anastomosis and a polypoid tumor distal to right uretero-ileal anastomosis. Histological examination revealed both tumors to be grade II transitional cell carcinoma. This rare case is discussed and the literature is reviewed.

[A case of esophageal cancer metastatic to the kidney presenting as renal pelvic cancer].

A 50-year-old man, who had undergone operation of esophageal carcinoma 2 years earlier, was admitted with the complaints of right flank pain and macroscopic hematuria. Intravenous urogram showed right unvisualized kidney. Right retrograde pyelography showed the dilatation of calices and irregularity of middle and lower calices. Computed tomography revealed severe hydronephrosis of the right kidney. Right nephrectomy was performed under the diagnosis of either renal pelvic cancer or esophageal cancer metastatic to the kidney. Pathological examination revealed metastatic squamous cell carcinoma from esophagus. The patient was treated by radiotherapy but died 4 months after the surgical treatment. Literature on eight case of metastatic renal cancer from esophagus is reviewed.

[Hautmann's ileal neobladder: experience of 37 cases].

Between April 1993 and August 1995, a Hautmann's ileal neobladder was created in 37 men after total cystectomy for bladder cancer. Ureteroileostomy was performed using a submucosal tunnel instead of the Le-Duc Camey procedure. There was no operative mortality and only a few early complications. The mean postoperative follow-up time was 16 months, with a range of 3 to 31 months. Hydronephrosis occurred in 3 patients, being caused by stenosis at the uretero-ileo anastomosis in 2 and by proximal stenosis in 1. Neobladder-ureteral reflux did not occur in any of the patients. Postoperative ileus developed in 3 patients, and one required laparotomy. Stenosis of the urethro-ileal anastomosis developed in 3 patients, who were successfully treated by transurethral incision. Thirty five patients achieved daytime continence, while 2 patients had slight incontinence. Twenty nine patients achieved nighttime continence, and most of the patients awoke 1-4 times to prevent overflow incontinence. The mean maximum flow rate, average flow rate and post-voiding residual urine volume were respectively 15.3 ml/sec, 5.5 ml/sec and 81 ml at 6 months postoperatively, and 14.9 ml/sec, 5.4 ml/sec and 76 ml at 12 months. Four patients with more than 100 ml of residual urine required sterile intermittent catheterization 2-4 times a day. Urethral recurrence was detected in 2 patients. One was treated with transurethral resection and cisplatinum-based systemic chemotherapy, and the other required urethrectomy and urinary diversion using a new continent efferent limb.

[Clinical outcome of radical prostatectomy and pelvic lymph node dissection].

Between September, 1987 and September, 1993, a total of 44 consecutive patients had undergone radical retropubic prostatectomy and pelvic lymphadenectomy for the treatment of prostate cancer. The patients were between 56 and 77 years (mean, 68 years). Eleven patients had clinical state A2 disease, 21 had stage B disease, and 12 had stage C disease. Fourteen of the 44 patients (32%) had positive lymph node metastases. The 5-year survival rate for patients with pT1, pT2 and pT3 was 100%, 71% and 87%, respectively. It was 77% in patients with positive node disease and 90% in patients with negative node disease. The 5-year disease-free survival rate for patients with pT1, pT2 and pT3 was 82%, and 78%, respectively. It was 54% in patients with positive node disease and 88% in patients with negative node disease. In 14 positive node patients, metastases were located in obturater nodes in 8 patients (57%), hypogastric nodes, in 6 patients (43%), external iliac nodes in 6 patients (43%), common iliac nodes in 4 patients (29%) and presacral nodes in 2 patients (14%). We confirmed that radical retropubic prostatectomy is effective treatment for locally confined prostate cancer and removal of obturater, hypogastric lymph nodes and the internal chain of external iliac lymph nodes is important in detecting metastases.

[Statistical analysis of tumors of the renal pelvis and the ureter--determinants of prognostic significance].

Sixty-two patients with epithelial tumors of the renal pelvis and the ureter were studied with respect to 16 clinicopathological factors and their relationship to the patients survival. The cumulative survival curves are depicted by the Kaplan-Meier method and the statistical difference in the survival rates were detected in 11 factors, age, tumor number, multicentricity, tumor size, histological tumor type, stage, grade, growth pattern, infiltration pattern, lymphatic invasion and venous invasion. Cox's proportional hazard model was applied to evaluate the contribution of these 11 factors to survival. With the univariate analysis, lymphatic invasion showed the greatest hazard ratio followed by growth pattern, stage, venous invasion, age, and grade in this order. Stepwise selection of these factors based on the relative magnitude of their contribution to the survival with Cox's proportional hazard model revealed the most important factor for survival as the lymphatic invasion (hazard ratio 5.29), followed by growth pattern (hazard ratio 2.89). In conclusion, patients with tumor lymphatic invasion and tumor of non-papillary growth pattern showed poor prognosis, and adjuvant chemotherapy should be performed on them to improve their survival.

[Female urethral carcinoma: results of irradiation in 2 patients].

Urethral carcinoma in 2 females has been treated with irradiation together with adjunct chemotherapy. In case 1, a 73-year-old female with squamous cell carcinoma was successfully treated with irradiation of 4,000 rad and peplomycin of 60 mg intravenously given. She has been free from the disease for the past 43 months. In case 2, a 61-year-old female with transitional cell carcinoma was initially treated with irradiation of 5,000 rad together with peplomycin 90 mg, which was followed by another 5,000 rad irradiation. The tumor recurred and the patient was operated on for cystourethrectomy and partial resection of the vagina. A further chemotherapy of cisplatin, peplomycin, and mitomycin C was instituted. She died of the tumor recurrence 23 months after the first visit to our clinic. Diagnosis and treatment modalities on the female urethral carcinoma are briefly discussed.

[Long-term results and quality of life of hemi-Kock orthotopic ileal neobladder after radical cystectomy].

We analyzed the long-term results and the quality of life in patients who received orthotopic lower urinary tract reconstruction using the Kock ileal neobladder. Between July 1990 and October 1993, 37 consecutive patients including 2 females received orthotopic hemi-Kock neobladder after radical cystectomy. In these patients, we analyzed the urinary continence, complications and urethral recurrence, and performed a questionnaire survey by mail. Good continence all day had been achieved in 71% of the patients 4 years after surgery. The rate of the pouch-related complications requiring reoperation was 27%. There was no urethral recurrence. Compared with preoperative conditions, 42% were not satisfied with urination. In these dissatisfied patients, the need to use pads in the daytime, sensation of residual urine and weak urine stream were significantly more frequent than in satisfied patients. In summary, the rate of complications was higher than that of other methods. However, the Kock orthotopic ileal neobladder is a stable procedure providing good function over the long-term.

[Clinical study of iohexol in excretory urography].

Excretory urography was performed using iohexol (Omnipaque 300 and Omnipaque 350) on 388 patients requiring urography in the Department of Urology, Nagoya University School of Medicine and 10 affiliated hospitals. Adverse reactions were observed in 3 cases (0.8%), but they were all mild. Good image efficacy was obtained in more than 95% of the patients injected 20 ml, 40 ml, and 100 ml of Omnipaque 300 and 40 ml of Omnipaque 350. There was no difference in the results of image efficacy between 40 ml (Omnipaque 300) and 100 ml (Omnipaque 300) groups. Therefore, the use of 40 ml of Omnipaque 300 for excretory urography was considered to be a very useful screening method for the urinary tract.