Hiroto Washida

Computerized tomography in acute pyelonephritis: the clinical correlations.

Computerized tomography was performed on 19 patients diagnosed as having uncomplicated acute pyelonephritis. The relationship was investigated among the laboratory findings, presence of flank pain, clinical course and severity of the lesions detected by computerized tomography. In patients febrile for less than 2 weeks healing as assessed by computerized tomography took an average of 76 days. However, in patients with repeated febrile episodes occurring for longer than 2 weeks healing was delayed until an average 232 days after onset. Computerized tomography findings generally correlated well with the erythrocyte sedimentation rate, C-reactive protein level, and presence of pyuria and flank pain. However, in patients with a prolonged course computerized tomography proved to be a more reliable indicator of progress than either the results of laboratory tests or the symptoms. In conclusion, computerized tomography was useful in the diagnosis, assessment of severity and evaluation of healing of acute pyelonephritis.

Immunohistochemical Analysis of c-erbB-2 Oncogene Product and Epidermal Growth Factor Receptor Expression in Human Urinary Bladder Carcinomas

Expression of the product of the c‐erb 6–2 gene, a protooncogene related to, but distinct from c‐erb B‐1 encoding the epidermal growth factor receptor (EGF‐R), was investigated in human urinary bladder carcinomas. In addition, levels of EGF‐R and transferrin receptor were also analyzed using an immunohistochemical approach, and the results compared with histological pattern and grading, and tumor staging. Increased expression of c‐erb B‐2 product was found in 32% of cases (7/22), a positive reaction being observed in 60% of transitional cell carcinoma (TCC) Grade 3 lesions (3/5), 20% of Grade 2 TCCs (2/10) and 100% of adenocarcinomas (AC) (2/2), but in none of the cases of squamous cell carcinoma (SCC). Although no statistical correlation with staging was evident, TCCs or SCCs of high grade and stage often showed EGF‐R‐positive staining, whereas other well differentiated lesions and normal bladder epithelium were generally negative. Most cases of urinary bladder carcinoma were positive for the transferrin receptor, which was not detected in normal bladder. The results thus suggested that a positive reaction for c‐erb B‐2 product is correlated with TCC histological grading or AC morphology. A high intensity of EGF‐R staining in human bladder carcinomas may be associated with poor differentiation and invasion, whereas transferrin receptor expression might reflect tumor growth.

Comparison of enzyme phenotypes in human bladder tumours and experimentally induced hyperplastic and neoplastic lesions of the rat urinary bladder: a combined histochemical and immunohistochemical approach

SummaryThe expression of a number of enzymes involved in drug metabolism, membrane function etc. was compared in hyperplastic and neoplastic lesions of the rat bladder and in human bladder tumours. Transitional cell carcinomas (TCC) in both rat and Man were characterized by decreased alkaline phosphatase (ALP) and increased gammaglutamyl transpeptidase (GGT), β-glucuronidase (β-Gl), succinate dehydrogenase (SD) and glucose-6-phosphate dehydrogenase (G6PD) activities. In addition, binding for antibodies specific for different cytochrome P-450 species (UT50, PB3a, MC1, MC2) and microsomal epoxide hydrolase (mEHb) was elevated in both murine and human tumours. Comparison of the enzyme phenotype in hyperplastic lesions induced by freeze ulceration or uracil administration with that in preneoplastic papillary or nodular hyperplasia (PNH) and TCC suggested, however, that most of the alteration in enzyme content or activity was non-specific and related to requirements for epithelial cell proliferation. On the other hand, the decreased ALP, and increased GGT and β - Gl activity appeared more directly related to neoplastic transformation. The results suggested that qualitative differences exist between reactive hyperplasia and preneoplastic or neoplastic lesions in the urinary bladder. The finding of increased cytochrome P-450, in clear contrast to the reduction characteristic of preneoplastic hepatic lesions, may be important with regard to the observed difference in neoplastic transformation between the bladder and liver in response to drug metabolising enzyme inducers.

Humoral immunity following double-freezing of the prostate in patients with prostatic cancer☆

In these studies, double freezing of the prostate was applied to 10 patients with a confirmed histologic diagnosis of stage C and D carcinoma. The clinical courses in the first group (five patients) were favorable. In the second group (two patients), death by cachexia occurred due to the cancer. In the third group (three patients), death 4 weeks after the second cryosurgery suggests the effects of Cryoshock. In the first and second groups, the results of immunologic examinations after the second freezing did not attain the predicted levels. Comparing the results of the third group with those of the first and second groups, the primary difference was that the percentages of gamma globulins and IgE were higher in the third group preoperatively. These findings suggest that in patients with high gamma globulin percentages and high IgE levels cryosurgery of the prostate is contraindicated.

Effect of cryosurgery of the prostate in serum gonadotropin levels in prostatic cancer

Pituitary gland response to releasing hormone using the LH-RH loading test before and 4 weeks after cryosurgery of the prostate was investigated in eight patients with advanced prostatic carcinoma. In pre- and postoperative comparisons of all patients, there were no significant differences detected before and after surgery. But pituitary response to the releasing hormone was compared before and after the surgery in each of the patients; in one, depression and facilitation of FSH and LH secretion, respectively, were observed and there was a variation in the response of gonadotropin in each patient. Although the number of observable patients is still too low to draw any definite conclusions from the test results, one possible interpretation is that cryosurgery of the prostate may influence hormonal secretion from the pituitary gland.

Tissue effects in the bladder wall after contact Nd: YAG laser irradiation for bladder tumors

SummaryA total of 17 patients underwent total cystectomy at 1–8 weeks following transurethral contact Nd: YAG laser destruction of bladder tumors (TULD) between February 1984 and December 1990. The laser-irradiated areas were studied pathologically. Five principal results were obtained. First, the irradiated areas were sharply bound from the nonirradiated area and featured ulceration and granulation associated with intensive edema. Second, fibroblast cells and fibrous cells appeared and new vascular growth was manifest; by approx. week 8 postirradiation, carbonized foreign bodies had been incorporated into the granulation and giant cells could be seen ingesting the foreign bodies. Third, neither perforation nor thermal damage to the intestine occurred. Fourth, the irradiated beds were suspected of harboring residual cancer cells in cases at stage T3. Finally, contact irradiation did not result in the transplantation of cancer cells.

Interstitial Laser Irradiation for Bladder Cancer

In recent years, the Nd:YAG laser has. been successfully applied in endoscopic urology for the bladder tumor (1)(2). All of the methods, however, are no-contact i. e. beam irradiation, there are limits in ability of laser surgery for bladder tumor. We have succeeded to develope a new contact laser probe, namely “Laser Endo Rod (ER)” for transurethral endoscopic laser surgery. (3)

A new device for simple chain cystography

SummaryA new device for chain cystography is described, which was developed to enable an easier and more comfortable insertion of the chain. The device consists of a Teflon tube containing a fine chain, a Y-shaped connecter, and a tube for the injection of contrast medium. Repeat catheterization for instilling contrast medium can be avoided, because the chain is pushed into the bladder by forcing the flow of the contrast medium simultaneously. The procedure is simple, and the chain is painlessly placed in the urethra without failure. To date, no difficulties have been encountered.

Cecoureterocele. A case report

A case of cecoureterocele in a 22-month-old girl is reported. She was admitted because of recurrent urinary tract infection associated with fever and dysuria. Excretory urogram showed a left duplex kidney with hydroureteronephrosis of the upper and lower moieties. Although the left upper moiety was hypofunctioned, some excretion of contrast medium was noted. Voiding cystourethrography demonstrated reflux into the left upper moiety, and a prominent dilation of the bladder neck and the urethra. Bladder sonography demonstrated an ectopic ureterocele at the bladder neck, and it was diagnosed as a cecoureterocele by endoscopic examination. Left pyelopyelostomy, total ureterectomy from the left upper half kidney and open resection of the ureterocele were performed together with reimplantation of the left lower ureter using Cohen technique in 1 stage. At the operation, the left lower ureter was confirmed as a typical obstructive megaureter. Convalescence was uneventful, and postoperative excretory urogram revealed an improvement of the left pyeloureterogram. But the postoperative voiding cystourethrography showed a remnant of cecoureterocele in the urethra causing bladder outlet obstruction. Endoscopic incision of the remnant cele wall in the urethra resulted in marked improvement in voiding and complete resolution of urinary tract infection. A brief review of cecoureterocele was given.

Evaluation Of The Contact Nd:Yag Laser Therapy For Bladder Cancer

Transurethral laser destruction using contact Nd:YAG laser (TULD) was performed on 96 occasions in 72 patients from February 1984 to December 1987. For the purpose of cure, TULD was undertaken on 59 occasions in 37 patients with primary bladder cancer. In the 59 occasions, usefulness of the TULD was evaluated. The cancers were classfied and staged in accordance with the Japanese Urological Association. The usefulness of the TULD was judged by surgeons with criteria as follows: degree of difficulty of manipulation, degree of destruction of the cancers, and bleeding during the TULD. Features of the cancers, for which the TULD was judged as useful, were summarized as follows: 1. On cystoscopical findings, the form of the cancer was superficial, the number of cancers were under the number of four and the sizes of the cancers were under 3 cm in diameter. 2. On pathological findings, the grade of the cancers reached grade II and the stage of the cancers reached stage T1.