Masaaki Nakazono

Flow cytometry based on heterogeneity index score compared with urine cytology to evaluate their diagnostic efficacy in bladder tumor

Flow cytometric (FCM) examination of DNA distribution based on heterogeneity index score (HIS) and ploidy pattern and of bladder irrigation specimens were compared with conventional urine cytologic examinations to evaluate the diagnostic efficacy of each method. Of 56 patients with histologically proved bladder tumors, 24 (43%) had positive urine cytology, 41 (73%) had positive FCM, and 45 (80%) had positive urine cytology and/or positive FCM. When bladder tumors were graded histologically, 8 of 11 patients (73%) with grade I bladder carcinoma, 22 of 28 patients (79%) with grade II, and 15 of 17 patients (88%) with grade III had positive urine cytology and/or positive FCM. Of the 28 patients with grade II, 12 with positive urine cytologic results had higher mean HIS (117.5) when compared with 16 (61.1) in whom urine cytology was negative. Of those who continued to have positive FCM in the face of negative findings on cystoscopic and urine cytologic examinations during follow-up, 3 patients eventually were found to have tumors (2 distal ureter, 1 bladder). These results indicate that FCM examinations for DNA distribution of bladder irrigation specimens are as useful as conventional urine cytology in the management of bladder tumors, can be more sensitive for detection and monitoring of the disease, and can contribute further to accurate diagnosis of the disease when combined with conventional urine cytology.

A preliminary study of chemotherapeutic treatment for bladder tumors.

Our objective was to develop new methods of chemotherapeutic treatment for bladder tumors. Once or twice a week under cystoscopy 10 to 20 mg, doxorubicin hydrochloride were administered directly into the tumors. This procedure was repeated until the size of the tumors was reduced or had disappeared completely under cystoscopic study. A new type of flexible needle was fabricated for this purpose. In 9 patients studied the total success rate was 78%. No significant side effects were seen in any of the patients.

Pre-operative intra-arterial chemotherapy for bladder cancer

SummaryThirteen partients with carcinoma of the bladder have been treated by arterial infusion of doxorubicin hydrochloride pre-operatively. Teflon catheters 0.25 mm in diameter were inserted by the Seldinger technique and the tips were placed in the aorta between the origin of the inferior mesenteric artery and the aortic bifurcation. The doses administered ranged from 80 mgs to 250 mgs with an average of 125 mgs. A response rate of 69% was seen. In 3 cases tumours disappeared; in a further 6 patients some tumour regression was apparent. One patient died from cardiac insufficiency. Although this method of treatment remains to be fully evaluated, preliminary results suggest that it may be an effective pre-operative treatment.

Disseminated Metastatic Ureteral Melanoma: A Case Report

AbstractA 74-year-old Japanese woman with a disseminated metastatic melanoma in the right ureter is described.

Erratum: Loss of blood group A antigen expression in bladder cancer caused by allelic loss and/or methylation of the ABO gene (Laboratory Investigation (2005) 85 (895-907) DOI: 10.1038/sj.labinvest.3700268))

Correction to: Laboratory Investigation (2005) 85, 895–907. doi:10.1038/sj.labinvest.3700268 Following the publication of the above paper, the author has identified an error in the affiliation of Dr Setsuo Hirohashi. The correct affiliation for Dr Hirohashi is shown above.

A modified procedure for construction of a Kock continent ileal urinary reservoir: Nonafferent limb procedure

SummaryA modified technique for the construction of a Kock continent ileal urinary reservoir (Koch pouch) is reported. Our procedure avoids the afferent limb mechanism by direct uretero-pouch anastomosis using the Le Duc-Camey procedure; the nipple valve of the efferent limb is fixed directly to the pouch wall by the King procedure. This modified procedure was used in five patients with invasive bladder cancer, and the postoperative condition of the urinary tracts were periodically evaluated by image diagnostic techniques. Neither hydronephrosis nor hydroureter was observed during the study period. Pouchography and pouchometry were done in all cases studied; no pouch-ureteral reflux was observed, and both day-and night-time continence were maintained in all cases. No patient has thus far had problems with selfcatheterization. This modified technique could be a promising operative approach for the construction of a continent ileal urinary reservoir.

Continent urinary reservoir (CUR) for supravesical diversion. Pouchmetric properties of the colonic CUR and role of detubularization

Eight patients underwent pouchmetry at 12 months after creation of the colonic continent urinary reservoir (CUR) for supravesical diversion. Pouchmetry revealed a volume-dependent tonic and phasic increase in pouch pressure in 3 patients who had undergone pouch construction using the partially detubularized right colon (Heineke-Mikulicz type closure after splitting the transverse and ascending colon at the antimesenteric border), whereas the volume-dependent phasic increase in pouch pressure was much less remarkable in 5 patients whose pouch was constructed using the totally detubularized right colon (Heineke-Mikulicz type closure after splitting the whole colonic segment including the cecum). The maximum pouch pressure at the pouch volume of 400 to 500 ml was significantly higher (p less than 0.05) in the partial detubularization group (46 +/- 6.0 cmH2O, mean +/- S.D.) than in the total detubularization group (12 +/- 1.6 cmH2O). In creation of the low-pressure pouch using the right colon, detubularization should extend to the whole portion of the isolated colonic segment.