Maruyama Y

Sarcomatoid carcinoma of the ureter: a case report.

We report a case of sarcomatoid carcinoma of the ureter in a 60‐year‐old woman who presented at our hospital with right flank pain. She had undergone total ovariectomy and radiation therapy for ovarian cancer at the age of 40 years. A diagnosis of ureteral tumor (cTsNOMO) led to radical right nephroure‐terectomy and partial cystectomy. Microscopic examination showed a tumor that contained areas of both sarcoma and transitional cell carcinoma. The carcinomatous tissues were blended into the sarcomatous areas and there was a transitional zone between the 2 components. Immunohistochemical examination showed that the spindle cells were positive for cytokeratin, so the final diagnosis was sarcomatoid carcinoma of the ureter. The patient has remained well without any evidence of recurrence for 5 months since the operation. There is no effective adjunctive therapy, so constant careful monitoring will be necessary. Sarcomatoid carcinoma of the ureter is a rare tumor and this is only the sixth case reported in Japan.

A possible role for leptin in normo- or hypoparathyroid uremic bone in postmenopausal dialysis women.

Abstract Leptin has been proposed to be a key molecule involved in energy regulation. Based on the generally acknowledged concept that a heavier person has a higher bone density, leptin is thought to be potentially involved in bone metabolism. Serum leptin, various bone markers, and bone mineral density (BMD) were studied in 51 dialysis patients (26 men and 25 women). The serum concentrations of leptin in dialysis patients ranged from 0.7 to 10.4 ng/ml (mean 3.2 ± 2.1 ng/ml) for males and from 1.4 to 44.6 ng/ml (mean 11.8 ± 10.4 ng/ml) for females. There was a good correlation between the body mass index (BMI) and leptin concentration in both male and female patients (P < 0.05). Serum leptin levels also correlated well with the age-adjusted z-score for BMD (P < 0.02) and were inversely correlated with levels of the carboxy-terminal propeptide of type I procollagen (P < 0.05) in females patients, but not in male patients. In conclusion, these results suggest an actual contribution of serum leptin in maintaining bone density in postmenopausal female dialysis patients.

Neoadjuvant Therapy for Locally Invasive Bladder Cancer

The present investigation was conducted to examine the effect of neoadjuvant PVB and CAP regimens for locally invasive bladder cancer and consisted of two studies: (1) a retrospective nonrandomized study of neoadjuvant PVB therapy, and (2) a well-controlled randomized study of neoadjuvant CAP therapy. A total of 25 patients with primary locally invasive bladder cancer were entered into the PVB study between January 1981 and December 1985. Since 1986, 31 patients have been randomized into the CAP study. In the PVB-treated group, a 71.4% complete response (CR) plus partial response (PR) rate and a 71.4% downstaging were noted. On the other hand, in the CAP-treated group, a 50.0% CR plus PR rate and a 88.9% downstaging were noted. The 2- and 5-year survival rates of neoadjuvant PVB were 78.6 and 60.6%, respectively. In contrast, the 2-year survival rate of the neoadjuvant CAP-treated group was 100% at a mean follow-up of 15.8 months. No statistical significance was achieved in the survival rates. These results indicated that neoadjuvant PVB and CAP would be useful in the management of invasive bladder cancer.

The optimum concentration of dialysate Ca++ using citrate

クエン酸透析において, クエン酸中毒のriskを除き, かつ十分な抗凝固効果を得るためには, 回路内至適クエン酸濃度は1.0-1.5mM必要であり, この場合回路内Ca++濃度は0.6-0.8mMであることを, すでに確認し報告したが, 今回, 回路内至適クエン酸濃度1.0-1.5mMでの透析液至適Ca++濃度を検討した.ホロファイバー型ダイアライザーを用い, 回路流量200ml/min, 透析液流量500ml/min, 回路内Ca++濃度を一定に保つために2% CaCl2液を注入し, 回路リザーバー容量を10lに設定した再循環式閉鎖型回路を作製した. 動脈側よりチトラール30ml/hrを注入し, 回路作動後15分, 30分, 60分, 90分に, リザーバー出口, 動脈側, 静脈側の3点で試料採取を行った. Ca++濃度0mM, 0.5mM, 1.0mM, 1.5mMの透析液を採取し, 比較検討した.透析液Ca++濃度0mM, 0.5mMの場合, 動脈側, 静脈側ともに, 50%前後の回路内Ca++濃度の抑制が見られた. 一方, 透析液Ca++濃度1.0mM, 1.5mMでは動脈側で約50%の回路内Ca++濃度の抑制を得るが, 静脈側では殆ど抑制効果は認めなかった. したがって, クエン酸透析における至適透析液Ca++濃度は0.5mMと考える.