Akio Maru

Primary aldosteronism due to adrenal cortical carcinoma.

We report a rare case of primary aldosteronism due to adrenal cortical carcinoma. Endocrinological data showed an isolated excess of aldosterone production without any associated increase in other steroids. Adrenal scintigraphy, which has not been described in cases of primary aldosteronism due to adrenal cortical carcinoma, revealed an increased uptake of the radionuclide into the affected adrenal gland without suppression in the contralateral gland.

Benign fibrous histiocytoma of the kidney

A case of benign fibrous histiocytoma of the kidney in a 48-year-old man is reported. A 7-year followup has revealed no recurrence. To our knowledge there have been no previous reports of benign fibrous histiocytoma of the kidney.

Paraganglioma of Urinary Bladder, Visualization with 131I-MIBG Scintigraphy

Three cases with paraganglioma of urinary bladder are described. All cases complained of palpitation, headache and paroxysmal hypertension after micturition. 131I metaiodobenzylguanidine scintigraphy successfully visualized the tumor of the bladder in all three cases.

A variant form of arylsulfatase A in human urine derived directly from the renal pelvis: kinetic and immunological characterization.

Arylsulfatase A (aryl-sulfate sulfohydrolase, EC 3.1.6.1) was examined in voided and in nephrostomic urine. A variant form of the enzyme was found in nephrostomic urine, in addition to the minor form, which is the sole component of arylsulfatase A in voided urine. The nephrostomic enzyme differed from the voided urine enzyme with respect to the kinetic parameters, the isoelectric point, heat stability and immunological reactivity. The isoelectric points of the voided urine and nephrostomic enzymes were 4.7 and 5.3, respectively. The nephrostomic enzyme was more heat-labile at 62.5 degrees C than the voided urine enzyme. Although the Km values of the two enzymes with nitrocatechol sulfate as substrate were almost the same, the V value of the nephrostomic enzyme was approx. one-hundredth that of the voided urine enzyme. The molecular weight (almost 130 000) did not differ between the voided urine and nephrostomic enzymes. It was demonstrated by various methods, using IgG antibody against the purified voided urine enzyme, that the nephrostomic enzyme was antigenically distinct from the voided urine enzyme.

Evaluation of systemic chemotherapy with methotrexate, vinblastine, Adriamycin, and cisplatin for advanced bladder cancer*

SummaryIn a cooperative study of the Japanese Urological Cancer Research Group for Adriamycin, the usefulness of chemotherapy with methotrexate, vinblastine, Adriamycin, and cisplatin (M-VAC therapy) in treating advanced or recurrent bladder cancer was examined. Evaluation of the clinical responses obtained in 86 evaluable patients revealed 13 complete responses, 29 partial responses, 4 minor responses, 19 cases of no change, and 21 cases of progressive disease. The overall response rate was 48.8% (42/86). The rate of response to M-VAC therapy at each disease site was as low as 21.4% (3/14) in bone lesions but exceeded 40% in the primary lesion, the lymph nodes, the lung, the liver, and other lesions. The clinical response to M-VAC therapy was not significantly influenced by the performance status of the patients, the dose intensity, or previous therapy. The median duration of response for the 42 responders was 22.7 weeks (range, 8.1–134.1 weeks), and the median duration of survival for the 86 evaluable patients was 9.8 months. Side effects were frequently encountered; the patients experienced anorexia, nausea, vomiting, malaise, alopecia, and leukopenia, but all of these symptoms were tolerable.

Phase III trial of The Japanese Urological Cancer Research Group for Adriamycin: cyclophosphamide, adriamycin and cisplatinum versus cyclophosphamide, adriamycin and 5-fluorouracil in patients with advanced transitional cell carcinoma of the urinary bladder

SummaryA non-randomized clinical study on systemic combination chemotherapy was conducted by the Japanese Urological Cancer Research Group for Adriamycin to compare the effectiveness of CAP (cyclophosphamide 200–500 mg/m2, adriamycin 30–50 mg/m2 and cisplatin 30–50 mg/m2) and CAF (cyclophosphamide 200–500 mg/m2, adriamycin 30–50 mg/m2 and 5-fluorouracil 250 mg/m2) in 123 patients (104 evaluable) with advanced and/or metastatic cancer of the urinary bladder. Among 96 patients who were non-randomly selected to receive CAP, 4 achieved complete remission, 12 achieved partial remission, 7 achieved minor response, 30 had stable disease, and 43 had disease progression. The response in the 8 patients who received CAF were: partial remission in 1 and progressive disease in 7. The overall response rate to CAP therapy was 17%, as against 13% for CAF therapy. The median duration of survival with CAP was 29 weeks and with CAF, 22 weeks. The differences between the two groups in duration of survival and response rate were not statistically significant. Complete and/or partial remissions were observed in the lymph nodes, lung and liver in 32%, 24%, and 57% of cases, respectively. There was no objective response in bone metastasis. The main side effects of CAP were anorexia (88%), nausea and/or vomiting (81%), alopecia (65%), leukopenia (72%), anemia (48%), and renal dysfunction (17%). No patients died as a result of toxicity of these combination chemotherapy modalities.

Prophylactic chemotherapy for primary and recurrent superficial bladder cancer: preliminary results

SummaryA multicenter trial for postoperative prophylaxis of the recurrence of superficial Ta-T1, G1-G2 bladder cancer was performed. Eligible patients with primary or recurrent superficial bladder cancer were randomized into four groups. For the primary cases, intravesical instillation of drugs [group A, 20 mg Adriamycin (ADM)+200 mg cytosine arabinoside (CA) in 30 ml physiological saline; group B, 10 mg peplomycin (PEP)+200 mg CA in 30 ml physiological saline; group C, 2 mg neocarzinostatin (NCS)+200 mg CA in 30 ml physiological saline; and group D, control] was carried out once a week for 2 weeks, once every 2 weeks for 14 weeks, once monthly for 8 months, and, finally, once every 3 months for 1 year. For the recurrent cases, intravesical instillation of 20 mg ADM +200 mg CA in 30 ml physiological saline as described above and daily oral administration of another drug [group E, 300 mg/day UFT; group F, 200 mg 5-fluorouracil (5-FU)/day; group G, 30 mg ubenimex/day; and group H, no oral drug] was performed. The postoperative follow-up period was 3–36 months. A total of 193 primary cases and 121 recurrent cases of superficial bladder cancer were evaluated.The cumulative 12-month nonrecurrence rates for the primary cases were 86.2% in group A, 78.1% in group B, 82.1% in group C, and 68.4% in group D. The cumulative nonrecurrence rate obtained using ADM+CA (group A) was significantly higher than the control value. On the other hand, no significant difference was found in the cumulative nonrecurrence rates calculated for the recurrent cases, regardless of the oral drug given. Intravesical instillation of ADM+CA for primary superficial bladder cancer was considered to be useful, but the long-term effect of intravesical instillation remains to be elucidated. Further refinement of this regimen is necessary for effective prophylaxis of the recurrence of superficial bladder cancer.

Papillary Adenoma of the Bladder in a Patient with Intermittent Self-Catheterization

We report a case of papillary adenoma of the bladder. The patient had had intermittent self-catheterization for the previous 3 years. The tumors developed multiply and were identified on the trigone and posterior wall of the bladder. Dysplasia of the urothelium was associated in nontumorous areas. Transurethral resection of the tumors was performed. The tumor recurred 3 times for 3 years, but no malignant changes were identified.

Wilms tumor and nephrotic syndrome in male pseudohermaphroditism

A case is reported of a child with male pseudohermaphroditism in whom Wilms tumor developed at age twenty-two months. The tumor was treated accordingly, but the child subsequently died of nephrotic syndrome with renal failure at age thirty-two months. After reviewing the similar concurrence of these disorders described as a syndrome, it was suggested that they may have basic embryologic abnormalities in common and that all of them originate during embryogenesis. The importance of bearing this syndrome in mind in the management of a child with abnormal gonadal differentiation is stressed.

Clinical significance of multiple biopsies of nontumorous bladder mucosa in patients with bladder cancer

Multiple biopsy specimens obtained from nontumorous bladder mucosa were investigated histologically. An average of 3.6 specimens was taken in 142 transurethral resection operations for 112 patients with bladder cancer. The histological categories used were normal epithelium, metaplasia, hyperplasia and G1-G3 dysplasia. Thirty-seven patients (27.7%) had G2 less than dysplasia within normal looking bladder mucosa. In patients with high grade bladder cancer, the incidence of the association with dysplasia was 51.7%, which was significantly higher than the rates in patients with low or moderate grade bladder cancer (p less than 0.05). The tumor recurrence was observed in 45 patients of 102 patients who were followed with bladder preservation. The recurrence was seen in 13 of 19 patients (68.4%) with mucosal dysplasia in the previous operation. The rate was significantly higher than 38.6% in patients without dysplasia (p less than 0.05). Thus, the epithelial dysplasia seen in nontumorous bladder mucosa were associated with higher grade bladder tumors more often, and the histology of multiple biopsy specimens might be one of predictors for tumor recurrence in near future.