Hiroichi Kishi

Nuclear magnetic resonance imaging of a benign cystic teratoma in the retroperitoneum.

A retroperitoneal teratoma arising from the vicinity of the upper pole of the right kidney in an 18-year-old woman is described. The plain anteroposterior abdominal radiographs showed irregular calcific shadows with tooth-like calcifications within the right upper quadrant of the abdomen. The findings of a primary cystic teratoma in the retroperitoneum examined by computerized tomography and magnetic resonance imaging of the abdomen are presented. Sagittal and coronal magnetic resonance imaging scans were useful to determine the extent of the mass, and to distinguish the mass from adjacent structures and organs.

Primary testicular carcinoid tumor in a 19-year-old boy

This report describes a primary carcinoid tumor of the testis arising in a 19-year-old boy. Symptoms suggestive of a carcinoid syndrome were not noted in this case. The pathological specimen did not contain teratomatous components. Histochemically, the argyrophil reaction was positive. The immunohistochemical finding of immunoreactive cells for 5-hydroxytryptamine (serotonin) was also positive. To our knowledge, this is the youngest case to be reported.

Technetium-99m dimercaptosuccinic acid uptake in long-term catheterized kidney: Comparison with renal function

We studied 23 long-term catheterized kidneys in 14 patients. The uptake of 99mtechnetium dimercaptosuccinic acid (99mTc-DMSA) was measured at one- and two-hour intervals after injection, and the uptake was corrected for variations in renal depth. These values were compared with inulin, creatinine, and para-amino hippurate (PAH) clearances which were measured in each kidney by collecting urine through long-term catheterization. Correlation coefficient was obtained between PAH clearance corrected for the body surface area and the two-hour uptake of 99mTc-DMSA. The correlation coefficients between the two-hour uptake of 99mTc-DMSA and the clearance values are not significantly different from those between the one-hour uptake and the clearance values. Corrections of the uptake for variations in renal depth did not improve the correlation coefficients. The results show that 99mTc-DMSA is an excellent method to estimate the renal plasma flow and the one-hour uptake without correction for renal depth is clinically sufficient to evaluate the split renal function.

Acute pericarditis as a result of unusual metastasis of the visceral pleura in a patient with testicular seminoma

Abstract  A 30‐year‐old man with a left testicular swelling was referred to our hospital. We performed a left high orchiectomy based on a diagnosis of clinical stage II testicular cancer. Pathological specimens of the left testis showed seminoma. The patient underwent three courses of combined chemotherapy. The retroperitoneal lymph nodes were dissected and there were no viable cancer cells. Twelve years later a right testicular tumor was discovered. The patient underwent a right high orchiectomy. Pathological specimens of the testis showed seminoma, and the patient was treated with prophylactic irradiation. One year after discharge a metastasis was found at a left supraclavicular fossa. The patient was treated with combined chemotherapy and irradiation. Six months after the treatment he complained of dyspnea. We diagnosed the condition as pleuritis carcimatosa. Two days after irradiation to the left thorax the patient suffered a sudden and fatal cardiac arrest. Autopsy survey revealed pericarditis as a result of a direct invasion of visceral pleural metastasis.

Hemiresective reconstruction of a redundant ileal conduit with severe bilateral ileal conduit-ureteral reflux

Abstract  A 58‐year‐old man was referred to our hospital with high fever and anuria. Since undergoing a total pelvic exenteration due to bladder‐invasive sigmoid colon cancer, urinary tract infections had frequently occurred. We treated with the construction of a bilateral percutaneous nephrostomy (PCN), and chemotherapy. Although we replaced the PCN with a single J ureteral catheter after an improvement of infection, urinary infection recurred because of an obstruction of the catheter. Urological examinations showed that an ileal conduit‐ureteral reflux caused by kinking of the ileal loop was the reason why frequent pyelonephritis occurred. We decided to resect the proximal segment to improve conduit‐ureteral reflux for the resistant pyelonephritis. After the surgery, the excretory urogram showed improvement and the urinary retention at the ileal conduit disappeared. Three years after the operation, renal function has been stable without episodes of pyelonephritis. Here we report a case of open repair surgery of an ileal conduit in a patient with severe urinary infection.

Influence of Cytotoxic Chemotherapy on Superoxide Production by Neutrophils in Cancer Patients

The influence of cytotoxic chemotherapy on the number and function of peripheral neutrophils was studied in time sequence in 9 cancer patients; 6 patients with transitional cell carcinoma of urothelium treated with CAP, the combination of cyclophosphamide, adriamycin and cisplatin, and the other 3 with testicular tumor treated with PEB, the combination of cisplatin, etoposide and bleomycin. The neutrophil function was evaluated by the superoxide production, measuring chemiluminescence of the neutrophil suspension by a photometer. The peripheral neutrophil count (PNC) significantly (p < 0.01) decreased with the nadir count of 280 +/- 100/mm2 16.4 days after cytotoxic chemotherapy and recovered to the normal level by the next course. The neutrophil function declined significantly (p < 0.01) as PNC decreased, reached the minimum almost at the same time as PNC, and returned to the normal level by the next course. Of the 9 cases, the neutrophil function in 6 cases reached the minimum on the same day as that of PNC. The study shows that cytotoxic chemotherapy appears to impair the host defense mechanism in cancer patients not only in inducing neutropenia but also in deteriorating neutrophil function at the same time.