Satoshi Kitahara

Incidence and Properties of Renal Masses and Asymptomatic Renal Cell Carcinoma Detected by Abdominal Ultrasonography

Renal ultrasonography was performed in 45,905 adults, including 41,364 without any signs suggesting urinary tract malignancies, 1,667 with microscopic hematuria only and 2,874 with some signs of malignancy. Renal lesions were found in 355 adults (0.858%) in the asymptomatic, 39 (2.3%) in the microscopic hematuria and 75 (2.6%) in the symptomatic groups, respectively. Renal cell carcinoma was found in 35 (7.5%) lesions: 19 (5.4%) in the asymptomatic, none in the microscopic hematuria and 16 (21.3%) in the symptomatic groups. A total of 47 patients, including 12 other renal cell carcinoma patients transferred from related hospitals, was grouped into 28 without and 19 with symptoms. Primary tumor size and clinical stages were significantly smaller and lower, respectively, in the asymptomatic group than in the symptomatic group. Radical nephrectomy was performed in all but 2 asymptomatic patients. The 5-year survival rates after nephrectomy were 94.7 and 60.9% for the asymptomatic and symptomatic groups, respectively (p less than 0.01). The results indicate that ultrasonography is a useful tool to detect low stage asymptomatic renal cell carcinoma at low cost.

Successful treatment of metastatic adenocarcinoma of the urachus: report of 2 cases with more than 10-year survival.

Metastatic urachal cancer is often considered lethal. We report 2 cases of metastatic urachal carcinoma successfully treated with surgical excision followed by combinations of surgery, radiation, and chemotherapy against local recurrence and/or distant metastases, with a recurrence-free survival period of more than 10 years. These cases provide support for multimodal treatments of metastatic urachal cancer.

Effects of Prostaglandins E1 E2 and F2α on Contractility and cAMP and cGMP Contents in Lower Urinary Tract Smooth Muscle

Prostaglandin (PG) E1, E2 and F2 alpha contracted smooth muscle strips from male adult rabbit urinary bladder. Contractile responses to each PG were significantly greater in urinary bladder body than in urinary bladder base. The magnitude of contractile response to each PG was F2 alpha > E2 > E1 in both of the bladder body and the bladder base. These contractions were almost completely eliminated by a calcium entry blocker, verapamil but not by atropine, phentolamine, propranolol or tetrodotoxin. PG E1 and E2 significantly relaxed the male rabbit urethral smooth muscle strips, whereas PG F2 alpha contracted the urethral smooth muscle strips. Cyclic adenosine monophosphate (cAMP) but not cyclic guanosine monophosphate (cGMP) increased significantly after administration of PG E1 or E2 in the urethral muscle strip. These results suggest that the regional differences in the magnitude of contractile responses to PG E1, E2 and F2 alpha between the bladder dome and the base and also suggest the contractile differences of PG E1 and E2 for the urinary bladder and the urethra; contractions for bladder and relaxations for urethra. These results also demonstrate that contractions induced by PG E1, E2 and F2 alpha in urinary bladder smooth muscles and by PG F2 alpha in urethral smooth muscles are mainly mediated by calcium influx and that relaxations induced by PG E1 and E2 in urethral smooth muscles are mediated by cAMP but not by cGMP.

Secondary Treatment Failure without Anti-human Chorionic Gonadotropin Antibody in a Patient with Kallmann Syndrome

A 29‐year‐old man with Kallmann syndrome suddenly developed decreased semen volume, azoospermia, and facial hair loss after 11 years of successful human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) treatment. Anti‐hCG antibody was not detected in the patients serum. A high serum level of luteinizing hormone (LH) with nasal LH‐releasing hormone analogue administration failed to increase serum testosterone to a sufficient level. Testosterone injection after cessation of hCG and hMG therapy was able to improve semen volume, but not azoospermia. Resumption of hCG and hMG therapy after 6 months cessation partially restored spermatogenesis. The secondary failure of hCG and hMG therapy suggests a decrease of testicular sensitivity to LH as well as hCG.