Narumi Tsuboi

High-frequency endoluminal ultrasonography for staging transitional cell carcinoma of the bladder

OBJECTIVES To assess the feasibility and limitations of endoluminal ultrasound (ELUS) for clinical staging of bladder tumors. METHODS From 1998 to 1999, 32 patients with transitional cell carcinoma of the bladder were evaluated by high-frequency ELUS using miniature ultrasound transducers (20 MHz, 5.1F or 7.2F) before transurethral resection. Clinical staging using ELUS was compared with the results of pathologic staging. RESULTS Seventeen (94%) of the 18 patients with superficial tumors on ELUS were confirmed by pathologic examination to have Stage pTa (n = 12) or Stage pT1 (n = 5) disease, and 11 (63%) of the 14 patients with muscle-invasive tumors on ELUS were confirmed by pathologic evaluation to have Stage pT2a (n = 2) or Stage pT2b (n = 9) disease. In all of the misdiagnosed patients, the tumor lacked a well-defined base and was larger than 2 cm in size. It was difficult to distinguish between Stage Ta and Stage T1 tumors because of the limited resolution of ELUS and between Stage T2a and Stage T2b tumors because of its low penetration. CONCLUSIONS ELUS using a high-frequency (20 MHz), miniature ultrasound transducer is able to distinguish superficial tumors from those with muscle invasion. However, the lack of penetration of the sonographic beam places major limitations on the evaluation of the depth of the invasion in large (greater than 2 cm) tumors with a broad base.

Renal masses detected by general health checkup.

Abstract Background A total of 60 604 persons underwent a general health checkup at Toma Hospital, Saitama, Japan, between January 1993 and June 1997, and transabdominal ultrasonography (US) was performed on all persons. We investigated the usefulness of transabdominal US in detecting renal tumors during general health checkups.

Fixed-drug eruption caused by allylisopropylacetylurea

Keywords: fixed drug eruption; allylisopropylacetylurea; positive lesional patch test; bromvalerylurea; cross-sensitization; cutaneous adverse drug reactions; hypnotics and sedatives

Diagnosing the Location of Carcinoma in situ (CIS) of the Urinary Bladder Using Pirarubicin Hydrochloride

Introduction: No established technique for locating solitary carcinoma in situ (CIS) of the urinary bladder or CIS accompanying bladder cancer has been determined. Here we investigated whether the location of CIS of the urinary bladder can be macroscopically ascertained by instilling pirarubicin hydrochloride (THP) into the urinary bladder. Patients and Methods: We dissolved 50 mg of THP in 50 ml of distilled water, and instilled the resulting solution into the urinary bladder. After 5 min, the urinary bladder is examined using a cystoscope. The study group consisted of 30 subjects (23 men and 7 women). Results: THP uptake was seen in 19 flat (nontumorous) areas of the bladder mucosa in 13 patients. Of these, 11 lesions in 6 patients were confirmed to be CIS. THP uptake was also seen in flat malignant lesions such as bladder cancer invasion into the prostatic urethra, and in benign lesions such as chronic cystitis and urothelial hyperplasia. Conclusions: The present method can be useful to find easily and macroscopically the location of flat malignant lesions such as CIS.

Clinical Application of Video Image Flexible Ureteronephroscope for Diagnosis of Upper Urinary Tract Disorders

Ureteroscopy has become the diagnostic and therapeutic procedure of choice for many conditions of the upper urinary tract. Technology is progressing rapidly in endourology, facilitating both goals. As reported previously, we developed a 2F video image flexible ureteronephroscope. This instrument is the smallest caliber of all ureteronephroscopes available to date. Because of the small diameter the device can be inserted into the ureter cystoscopically in a manner similar to catheter insertion. The procedure is done with the patient under local anesthesia. We performed ureteronephroscopic procedures on 79 patients using mainly a 6F passively deflecting flexible ureteronephroscope, which consists of the aforementioned 2F video image flexible ureteronephroscope and a 3F working channel. The area to be viewed was accessed successfully in 41 of 43 patients (95%). Over-all, diagnostic maneuvers were successful in 64 of 79 patients (87%). We suggest that the 2F and 6F flexible ureteronephroscopes would be indicated when conclusive diagnosis for upper urinary disease is not obtained by other means.

Percutaneous nephrolithotomy: With emphasis on large renal stones

With utilization of safety guide wire, dilator (up to 36F), and Mazzariello-Caprini forceps, percutaneous removal of renal stone was successfully performed in 18 cases, including 5 cases with staghorn calculus, although parts of the staghorn calculus were left in 4 cases. Attempts at stone extraction were performed on the day nephrostomy was made. All of the renal stones excluding staghorn calculi were removed without disruption followed by satisfactory postoperative renal function. Unexpectedly Kocher forceps was found to be a useful and relatively safe instrument for quick fragmentation and removal of staghorn calculi.

Congenital mesoblastic nephroma

For more than a decade congenital mesoblastic nephroma of infancy has been recognized as an entity different from Wilms tumor in its clinical and histopathologic features. However, this tumor is sometimes confused with Wilms tumor and consequently, inadvertent and vigorous therapy compatible with that for Wilms tumor is given. we reviewed the literature and analyzed 90 cases of congenital mesoblastic nephroma in the English and Japanese literature. The importance of early and accurate histopathologic diagnosis of the resected specimen to avoid inappropriate post-operative therapy is emphasized, and the peculiar features of congenital mesoblastic nephroma are characterized.

Complete remission of renal cell carcinoma with lung metastases in two hemodialysis patients after low‐dose interferon therapy

A standard immunotherapy strategy for metastatic renal cell carcinoma (RCC) in dialysis patients has yet to be established. In this study, we report complete remission of RCC with lung metastases in 2 hemodialysis patients after low‐dose interferon therapy (Sumiferon® 3 × 106 international unit 3 times a week). These results suggest that interferon therapy is important for clear cell RCC with lung metastases in dialysis patients, even in the era of molecular‐targeted therapies.

Post-voiding repeated renal ultrasonography for slight hydronephrosis detected during screening for asymptomatic microhematuria.

Background : There is not a well established method for further screening of asymptomatic microhematuria found through annual health examinations. However, it is apparent that a large number of examiners are using ultrasonography for screening. When slight hydronephrosis is found through screening, it is difficult to determine whether further examinations, such as intravenous pyelography (IVP), should be performed. In this paper, we discuss the usefulness of post‐voiding repeated renal ultrasonography, which was applied to 57 patients with slight hydronephrosis found in a screening.

Papilloma of renal pelvis in childhood

A papilloma in the renal pelvis of a five-year-old girl is reported. The transitional cell tumors of the renal pelvis in the pediatric age group are reviewed, and this is found to be the first case of a benign papilloma in childhood. We believe this pathologic entity should be included in the differential diagnosis of hematuria in a child.