Distal finger reconstruction technique combining a distally-based finger flap and a partial toe flap.

BACKGROUND: Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe. PATIENTS AND METHODS: Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously. RESULTS: In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery. CONCLUSION: Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.

Acute Spinal Cord Infarction with Preferential Involvement of Ventral Gray Matter: An Autopsy Report.

Herein, we report abdominal aortic thrombosis as a rare cause of acute spinal cord infarction. A 78-year-old man with multiple vascular risk factors developed acute paraplegia with sensory and urinary disturbances and signs of ischemia in both lower limbs. The post-mortem study done 3 days after the onset of symptoms revealed a large coagulum in the abdominal aorta, distal to the renal arteries and extending to bilateral common iliac arteries; in addition, marked atherosclerosis was present in most large blood vessels. Premature incomplete necrotic foci were seen in the ventral gray matter of the spinal cord from T6 through S5; the surrounding white matter and dorsal gray matter were spared. Considering our autopsy case, spinal cord gray matter may be more vulnerable to ischemia than the white matter.

Navigation-Assisted Bone Grafting for Blowout Fracture.

BACKGROUND: Treatment of orbital floor fracture accompanied by extensive bone defect requires orbital floor reconstruction using a bone graft, but graft may deviate into the maxillary sinus when no bone capable of supporting the graft remains around the defect. In such cases, it is necessary to fix the grafted bone to the orbital margin, but the grafted bone placement site is subjectively decided based on inspection through a small incision in many cases, being dependent on the experience of operators, and it has been difficult to accurately determine the placement angle. METHODS: The authors applied a navigation system in 4 patients with orbital blowout fracture, and evaluated for the exact bone graft placement angle and orbital floor form during surgery. RESULTS: The bone graft placement angle was evaluated by comparison with a mirror image of the nonaffected side. The angle could be confirmed during surgery, as well as the lateral symmetry of the orbital form. On postoperative computed tomography, the grafted bone was retained at a favorable placement site. CONCLUSIONS: The navigation system may be useful to support the treatment of orbital blowout fracture, as it facilitates safe dissection around orbital floor bone defects, confirmation of the positional relationship between the bone fragment and orbital tissue and bone graft fixation position, and evaluation of lateral symmetry of the orbital floor form during surgery.

Chemical characterization of unburned carbon in coal fly ashes by use of TPD/TPO and LRS methods.

Functional forms of the unburned carbon present in six kinds of coal fly ashes have been examined mainly by the temperature-programmed desorption (TPD)/temperature-programmed oxidation (TPO) and laser Raman spectroscopy (LRS) methods. The carbon contents of the ash samples range from 0.4 to 4.1 mass%. The LRS analysis shows that the C consists of both amorphous and crystallized forms, and the proportion of the former is as large as 50-65 C%. Further, the TPD measurement exhibits that the C contains several types of surface oxygen species, such as carboxyl and lactone/acid anhydride groups, which can readily be decomposed into CO2 up to 700 °C to provide active carbon sites. The results of the TPD also indicate that the ashes have surface CaCO3, and most of this species can be converted to CaO and CO2 around 600-700 °C. Interestingly, there is a significant correlation between organic fluorine concentrations and carboxyl/lactone/acid anhydride groups or surface CaCO3 contents in the ash samples. It might thus be possible that the formation of organic F forms proceeds through gas-solid-solid interactions among HF (and/or F2) in flue gas, active carbon sites and surface Ca species produced around 600-700 °C downstream of coal-fired boilers.

Apparent diffusion coefficient value reflects invasive and proliferative potential of bladder cancer.

PURPOSE: To elucidate a role of apparent diffusion coefficient (ADC) value as a biomarker of bladder cancer, we investigated its associations with Ki-67 labeling index (LI) along with classical clinicopathological prognosticators. MATERIALS AND METHODS: Diffusion-weighted MRI (DW-MRI) at 1.5 Tesla using b-values of 0, 500, 1000, and 2000 s/mm(2) was prospectively taken before transurethral resection by 132 bladder cancer patients. ADC value of index tumors was measured and compared with clinicopathological prognosticators including Ki-67 LI. RESULTS: ADC value was significantly lower in tumors with higher Ki-67 LIs, sessile tumors (versus papillary), larger tumors, higher grade disease, and higher T stage disease. ADC value inversely correlated with Ki-67 LI (ρ = -0.57; P < 0.0001). On multiple regression analysis, T stage and Ki-67 LI significantly correlated with ADC value. The Akaike information criterion confirms these two parameters constitute the best model for determining ADC value. Similarly, T stage and ADC value significantly correlated with Ki-67 LI and these two parameters composed the best model for predicting Ki-67 LI. CONCLUSION: ADC value would reflect T stage and Ki-67 LI, representing invasive and proliferative potential, respectively. ADC value is likely to serve as a biomarker reflecting aggressiveness of bladder cancer.

Effect of carbazochrome sodium sulfonate on refractory chronic prostatitis.

OBJECTIVES: To study the effect of carbazochrome sodium sulfonate, an agent that reduces capillary permeability, on refractory chronic prostatitis. METHODS: Patients with prostatitis refractory to at least 8 weeks of routine therapy and with urinalysis positive for microhematuria were considered for the present study. In addition to their prior therapy, the patients received carbazochrome at a dose of 30 mg three times a day. The severity of pain (score 0-10), daytime and night-time frequency, international prostate symptom score, global self-assessment, urine occult blood positivity, and adverse events were assessed after 4 and 8 weeks of treatment, and compared with baseline findings. RESULTS: A total of 50 patients (mean age 68.6 ± 8.5 years) were evaluable. The pain score decreased significantly from 3.2 ± 2.1 at baseline to 1.7 ± 1.4 after 4 weeks of treatment and to 1.1 ± 1.8 after 8 weeks. Daytime and night-time frequency, storage symptoms, post-micturition symptoms, and urine occult blood positivity also significantly improved. More than 36% of the patients gave a global self-assessment rating of "improved" or "better" after both 4 and 8 weeks of treatment. Mild adverse events occurred in three patients; one had nausea and two developed drug rash. CONCLUSIONS: Carbazochrome seems to effectively improve pain as well as storage and post-micturition symptoms in patients with refractory chronic prostatitis.

Toward one Giga frames per second--evolution of in situ storage image sensors.

The ISIS is an ultra-fast image sensor with in-pixel storage. The evolution of the ISIS in the past and in the near future is reviewed and forecasted. To cover the storage area with a light shield, the conventional frontside illuminated ISIS has a limited fill factor. To achieve higher sensitivity, a BSI ISIS was developed. To avoid direct intrusion of light and migration of signal electrons to the storage area on the frontside, a cross-sectional sensor structure with thick pnpn layers was developed, and named "Tetratified structure". By folding and looping in-pixel storage CCDs, an image signal accumulation sensor, ISAS, is proposed. The ISAS has a new function, the in-pixel signal accumulation, in addition to the ultra-high-speed imaging. To achieve much higher frame rate, a multi-collection-gate (MCG) BSI image sensor architecture is proposed. The photoreceptive area forms a honeycomb-like shape. Performance of a hexagonal CCD-type MCG BSI sensor is examined by simulations. The highest frame rate is theoretically more than 1Gfps. For the near future, a stacked hybrid CCD/CMOS MCG image sensor seems most promising. The associated problems are discussed. A fine TSV process is the key technology to realize the structure.

Body weight reduction by exercise increases the urinary 3-methylhistidine excretion level with relatively positive nitrogen, sodium, and potassium balances when compared to dietary restriction.

Background: Regarding changes in muscle mass, differences due to types of exercise and/or nutritional interventions, and associations with nutrient balances are still unclear. Methods: To estimate changes in muscle mass during a body weight loss program using either a diet or exercise regimen, we investigated levels of muscle mass-related indices, and body contents of nitrogen, sodium, and potassium as measured by the balance method. Six healthy young adult male volunteers participated in two 10-day crossover experiments (20 days total). The first 5 days comprised an adjustment period (energy intake, 2656 ± 367 kcal/day (mean ± standard deviation)). During the second 5-day period, the participants either reduced their energy intake to 1770 ± 244 kcal/day (diet regimen) or exercised on a bicycle ergometer to expend 886 ± 122 kcal/day (exercise regimen). Results: The nitrogen, sodium, and potassium balances were significantly more positive during the exercise regimen than during the diet regimen. The urinary excretion levels of creatinine, 3-methylhistidine (3-MH), aldosterone, and catecholamines, and the 3-MH/creatinine ratio were significantly increased only during the exercise regimen. Conclusions: The exercise regimen suppresses the decrease in muscle mass-related indices during body weight loss compared to the diet regimen with a relatively positive state of whole-body protein, sodium, and potassium balances, accompanied by an increase in sympathetic/adrenal cortical functions.

Localization of propionibacterium acnes in granulomas supports a possible etiologic link between sarcoidosis and the bacterium.

Sarcoidosis likely results from the exposure of a genetically susceptible subject to an environmental agent, possibly an infectious one. Mycobacterial and propionibacterial organisms are the most commonly implicated potential etiologic agents. Propionibacterium acnes is the only microorganism, however, found in sarcoid lesions by bacterial culture. To evaluate the pathogenic role of this indigenous bacterium, we screened for the bacterium in sarcoid and non-sarcoid tissues using immunohistochemical methods with novel P. acnes-specific monoclonal antibodies that react with cell-membrane-bound lipoteichoic acid (PAB antibody) and ribosome-bound trigger-factor protein (TIG antibody). We examined formalin-fixed and paraffin-embedded samples of lungs and lymph nodes from 196 patients with sarcoidosis, and corresponding control samples from 275 patients with non-sarcoidosis diseases. The samples were mostly from Japanese patients, with 64 lymph node samples from German patients. Immunohistochemistry with PAB antibody revealed small round bodies within sarcoid granulomas in 20/27 (74%) video-assisted thoracic surgery lung samples, 24/50 (48%) transbronchial lung biopsy samples, 71/81 (88%) Japanese lymph node samples, and 34/38 (89%) German lymph node samples. PAB antibody did not react with non-sarcoid granulomas in any of the 45 tuberculosis samples or the 34 samples with sarcoid reaction. In nongranulomatous areas, small round bodies detected by PAB antibody were found in alveolar macrophages of lungs and paracortical macrophages of lymph nodes from many sarcoid and some non-sarcoid patients. Large-spheroidal acid-fast bodies, Hamazaki-Wesenberg bodies, which were found in 50% of sarcoid and 15% of non-sarcoid lymph node samples, reacted with both PAB and TIG antibodies. Electron microscopy revealed that these Hamazaki-Wesenberg bodies had a single bacterial structure and lacked a cell wall with occasional protrusions from the body. The high frequency and specificity of P. acnes, detected by PAB antibody within sarcoid granulomas, indicates that this indigenous bacterium might be the cause of granuloma formation in many sarcoid patients.

Characteristics of patients with subchorionic hematomas in the second trimester.

AIM: The aim of this study was to investigate the etiological characteristics of patients diagnosed with subchorionic hematoma. METHODS: A case-controlled study was performed to compare characteristics of patients and controls. Via ultrasound examination, 47 pregnant patients were found to have subchorionic hematomas and 1075 had no evidence of subchorionic hematomas (controls). In the second trimester, patients were compared with regard to endocervical Chlamydia trachomatis and other vaginal microorganisms. RESULTS: The overall incidence of subchorionic hematomas in this pregnant population was 4.2%. Maternal clinical characteristics did not differ between cases and controls. Evaluation of the vaginal flora revealed that the positive rates of coagulase-negative staphylococci (cases: 12.8%; controls: 4.1%; P<0.01) and Gardnerella vaginalis (cases: 12.8%; controls: 2.5%; P<0.001) in the cases were significantly higher than those of the controls. The negative rate of Lactobacillus in the cases was significantly higher than that of the controls (cases: 42.6%; controls: 27.6%; P<0.05). CONCLUSION: Pregnant women with subchorionic hematoma in the first trimester showed changes in vaginal flora in the second trimester, which suggests a possible association with subchorionic hematoma and vaginal flora change.

Combination of MS protein identification and bioassay of chromatographic fractions to identify biologically active substances from complex protein sources.

Purification of biologically active proteins from complex biological sources is a difficult task, usually requiring large amounts of sample and many separation steps. We found an active substance in a serum response element-dependent luciferase reporter gene bioassay in interstitial cystitis urine that we attempted to purify with column chromatography and the bioassay. With anion-exchange Mono Q and C4 reversed-phase columns, apparently sharp active peaks were obtained. However, more than 20 kinds of proteins were identified from the active fractions with MS, indicating that the purification was not complete. As further purification was difficult, we chose a candidate molecule by means of studying the correlation between MS protein identification scores and bioassay responses of chromatographic fractions near the active peaks. As a result, epidermal growth factor (EGF) was nominated as a candidate molecule among the identified proteins because the elution profile of EGF was consistent with that of the bioassay, and the correlation coefficient of EGF between MS protein identification scores and bioassay responses was the highest among all the identified proteins. With recombinant EGF and anti-EGF and anti-EGF receptor antibodies, EGF was confirmed to be the desired substance in interstitial cystitis urine. This approach required only 20 ml of urine sample and two column chromatographic steps. The combination of MS protein identification and bioassay of chromatographic fractions may be useful for identifying biologically active substances from complex protein sources.

[Langerhans cell histiocytosis of the rib in adult male].

A 57-year-old man was admitted to our hospital with an abnormal shadow on chest X-ray film. Computed tomography (CT) scanning demonstrated a low-density, destructive mass on the right 8th rib. The maximum standardized uptake value of the tumor measured by positron emission tomography (PET) was 2.9, indicating malignancy. Wide resection of the tumor, including the right 8th rib and the 7th to 8th intercostal muscle, was performed. Chest wall reconstruction was achieved with Composix Mesh. The histologic findings revealed proliferation of histiocytes and eosinophil infiltration. No malignant cells were detected in the tumor. Histiocytes stained for S-100 protein and CD1a, compatible with a diagnosis of Langerhans cell histiocytosis (LCH). LCH in the ribs is very rare and difficult to diagnose using CT or PET. Tumor biopsy or resection is needed to diagnose LCH.

Dietary glycine improves urine storage symptoms in urology outpatients.

OBJECTIVES: Spinal glycinergic mechanisms inhibit the micturition reflex, and administration of glycine inhibits bladder activity in rats. Therefore, we examined whether dietary glycine would improve storage symptoms in urological outpatients. METHODS: We enrolled 20 participants (16 men and four women) with an overactive bladder symptom score (OABSS) ≥ 3. All participants took 3 g of glucose (placebo) twice a day for the first four weeks, then 3 g of glycine twice a day for the next four weeks. We evaluated blood pressure, international prostate symptom score (IPSS), nocturia quality of life (N-QOL) score, OABSS, frequency of urination, sleep latency, time to first nighttime void, bladder pain, global self-assessment (GSA) evaluated urinary symptom improvement, and adverse events. RESULTS: Glucose administered as a placebo improved urinary frequency, urine force on the IPSS, and five of the 13 items on the N-QOL. However, compared to the results before and after glucose administration, glycine treatment decreased the number of nocturnal voids, urgency, and total score for urine storage items on the IPSS. It also reduced blood pressure and improved IPSS-QOL. For the OABSS, improvements with glycine were noted in the number of nocturnal urinations, urinary urgency, urge incontinence, and total score. For the N-QOL, eight of 13 items, and the total score, improved. The actual number of nighttime urinations, sleep latency, latency to first nighttime urination, bladder pain, and GSA also improved. There were no adverse events. CONCLUSIONS: Glycine might improve urine storage symptoms, cardiovascular function, pain, and sleep.

Conformational transitions of cyclic D,L-peptides.

Conformational transitions of cyclic D,L-hexapeptides have been studied by first-principles calculations. Geometry optimizations for 20 types of homoresidue cyclic D,L-hexapeptide revealed that the cyclic peptides have two types of energetically stable backbone (extended (E) and bound (B) types); and for each type, the amino acid side chains have two orientations (equatorial and axial). Among the four types of isomer [E-type equatorial (E(eq)), B-type equatorial (B(eq)), E-type axial (E(ax)), and B-type axial (B(ax))], B(ax) is the energetically most preferred by most of the 20 encoded amino acid residues, whereas E(ax) is the least preferred. A search for transition states indicated that six types of conformational transition are possible between the isomers of the cyclic peptide, i.e., the backbone-backbone conversions (E(eq)-B(eq) and E(ax)-B(ax) transitions), the side chain-side chain conversions (E(eq)-E(ax) and B(eq)-B(ax) transitions), and the simultaneous conversions of the backbone and the side-chain orientation (E(eq)-B(ax) and E(ax)-B(eq) transitions). All the six transitions proceed with the breaking of the high molecular symmetry (S(6)) and go through the triangular (C(3)) intermediate structure with either equatorial or axial side-chain orientation.

Helicobacter pylori invades the gastric mucosa and translocates to the gastric lymph nodes.

Helicobacter pylori has been considered to be non-invasive and to rarely infiltrate the gastric mucosa, even though there is an active Th1 immune response in the lamina propria of the H. pylori-infected stomach. To elucidate whether H. pylori invades the lamina propria and translocates to the gastric lymph nodes, we examined H. pylori in formalin-fixed and paraffin-embedded tissue sections of stomach and gastric lymph nodes obtained from 51 cancer patients using real-time PCR and immunohistochemistry (IHC) with a novel anti-H. pylori monoclonal antibody that recognizes lipopolysaccharides. Fresh gastric lymph nodes were used to culture for H. pylori. In 46 patients with H. pylori in the stomach, the bacterium was found in the lymph nodes from 21 patients by culture, 37 patients by PCR, and 29 patients by IHC. H. pylori captured by macrophages was found in the lamina propria of 39 patients. In the lymph nodes, the bacterium was found in many macrophages and a few interdigitating dendritic cells at the paracortical areas. H. pylori was also found in the intracellular canaliculi of parietal cells in 21 patients, but intracytoplasmic invasion into gastric epithelial cells was not identified. When compared to the commercially available anti-H. pylori antibodies, the novel antibody showed the highest sensitivity to detect H. pylori-positive macrophages, whereas no difference was found for H. pylori in the mucous layer. The H. pylori-positive macrophages in the lamina propria correlated with chronic gastritis as well as translocation of such cells to the lymph nodes. These results suggest that H. pylori-induced gastric epithelial damage allows the bacteria to invade the lamina propria and translocate to the gastric lymph nodes, which may chronically stimulate the immune system. The bacteria captured by macrophages, whether remaining alive or not, may contribute to the induction and development of H. pylori-induced chronic gastritis.

Remnant lipoprotein metabolism is improved more when body weight is reduced by exercise than by dietary restriction.

BACKGROUND: Remnant lipoprotein levels during weight-loss programs have not been examined in detail. We investigated the effects of reducing body weight by exercise and by dietary restriction on lipid metabolism including remnant-like particle-cholesterol (RLP-C) and apolipoprotein B48 (apo B48). METHODS: Six adult male volunteers participated in 2 experiments over 10 days. The first 5 days were an adjustment period (energy intake, 2656+/-150 kcal/day; mean+/-SEM). During the second 5 days, the participants either exercised on a bicycle ergometer to consume 886+/-50 kcal/day or reduced their energy intake to 1770+/-100 kcal/day. RESULTS: Serum triglyceride (TG) and RLP-C levels were significantly lower, whereas the increase in high density lipoprotein-cholesterol (HDL-C) level was significantly larger after exercise than after dietary restriction. We measured changes (Delta) in serum levels and identified positive correlations between Delta insulin and Delta TG, Delta apo B48 (p<0.05) and Delta RLP-C (p=0.050) only during exercise. CONCLUSIONS: Reducing body weight by exercise has more beneficial effects on lipid metabolism than a dietary approach, and improved insulin resistance accompanies the decrease of serum remnant lipoprotein levels.

Increase in insulin secretion and decrease in muscle degradation by fat-free milk intake are attenuated by physical exercise.

BACKGROUND: Protein intake, particularly branched chain amino acids (BCAAs), and exercise have opposing actions on insulin secretion, but the same action on protein anabolism. We examined the effects of BCAA-rich fat-free milk intake and/or exercise on levels of insulin secretion and indices related to muscle protein metabolism in order to assess the potency of dietary and exercise therapies against metabolic and locomotive disorders. METHODS: Eight adult female volunteers participated in all four 24 h experiments; control diet intake with or without exercise, and fat-free milk-containing diet intake with or without exercise. Fat-free milk was replaced with one-sixth of all foods in the control diet. Exercise was set at an equal-energy level as fat-free milk. Urine and fasting blood samples were collected for each experiment. RESULTS: Urinary C-peptide immunoreactivity excretion and serum insulin levels were significantly higher, but urinary 3-methyl-histidine excretion levels were significantly lower with low urinary adrenaline and dopamine excretion in the fat-free milk-containing diet than in the control diet. These findings were reduced by exercise with high urinary adrenaline and noradrenaline excretion. CONCLUSIONS: BCAA-rich fat-free milk intake enhanced insulin secretion and suppressed muscle protein degradation, but these effects are attenuated by exercise accompanied with increase in catecholamine secretion.

Progressive Encephalomyelitis with Rigidity and Myoclonus Resolving after Thymectomy with Subsequent Anasarca: An Autopsy Case.

Progressive encephalomyelitis with rigidity and myoclonus (PERM) is an autoimmune disorder involving the brainstem and spinal cord and is sometimes associated with thymoma. We encountered a 75-year-old woman with typical PERM features, glycine receptor antibody, and thymoma. Her neurologic symptoms improved after thymectomy, but she unexpectedly developed anasarca with massive pleural effusions and hypoalbuminemia and finally succumbed to death. The autopsy showed edema and mononuclear infiltration in the pleura but no neuropathological findings typical of PERM. Effective treatment of PERM can reverse the neuropathological signs of encephalomyelitis. The autoimmune nature of anasarca is possible but not proven.

Quantification of leukotriene B4 glucuronide in human urine.

We have developed a method for measuring leukotriene B4 glucuronide, a marker of systemic leukotriene B4 biosynthesis, in human urine. This method involves the separation of two positional isomers of leukotriene B4 glucuronide by high-performance liquid chromatography, followed by hydrolysis with beta-glucuronidase and then leukotriene B4 quantification by enzyme immunoassay after purification by high-performance liquid chromatography. One of two positional isomers of leukotriene B4 glucuronide was predominantly present in urine. The concentration of the isomer increased in urine from aspirin-intolerant asthma patients after aspirin challenge. Urinary leukotriene E4 and leukotriene B4 glucuronide concentrations in 13 normal healthy adults were 94.6 pg/mg-creatinine (median) and 22.3 pg/mg-creatinine, respectively. Urinary LTE4 concentration increased during the first 3h after allergen inhalation in atopic patients. However, allergen-induced bronchoconstriction was not associated with an increased concentration of LTB4 glucuronide in urine. The method enabled us to precisely determine urinary leukotriene B4 glucuronide concentration.

[Small cell carcinoma of the urinary bladder treated with neo-adjuvant cp chemotherapy (CPT-11 and CDDP): a case report].

We report a cases of primary small cell carcinoma of the urinary bladder. A 68-year-old man was referred to our hospital because of asymptomatic gross hematuria. Cystoscopy showed a solid tumor on the dome of the urinary bladder. Pelvic magnetic resonance imaging (MRI) revealed a mass lesion with extravesical extention, and computed tomography(CT) scan and bone scintigraphy showed no distant metastasis. Transurethral resection of the bladder tumor (TUR-BT) was performed. Histopathological findings of the specimen showed small cell carcinoma (> pT2), with transitional cell carcinoma (TCC), grade 2-3. We performed one course of neoadjuvant CP chemotherapy using Irinotecan (CPT-11) and Cisplatin (CDDP), followed by radical cystectomy. Histopathological finding of the specimen showed no evidence of malignancy. We performed one more course of adjuvant CP chemotherapy. He has been free of disease 7 months after operation.