Toshimitsu Misaki

Photoradiation Therapy of Bladder Tumors

Photoradiation therapy (PRT), in which hematoporphyrin derivative (HpD) is activated by an argon-dye laser, was performed on 46 superficial bladder tumors in 9 patients. It was suggested there is little or no thermal cell killing effect of laser irradiation from a study of the heating effect of the beam intensity. A fluorospectrophotometric study of biopsies from tumors and normal mucosa revealed preferential HpD localization in malignant tissues. In tumors less than 1 cm in diameter treated with 150 mwatts per cm2 for 5 minutes there were 2 with complete remission (CR) and 5 with no change (NC), whereas with 200 mwatts per cm2 or more for the same time there were 15 CR and 5 with partial remission (PR). Concerning the accumulated energy intensity of light, in tumors 1 cm in size or less, treatment with 100-250 joules per cm2 obtained CR in 5 of 6 tumors. From these results, it was suggested that the light intensity should be 300 mwatts per cm2 for 5-10 minutes or more and the total light dose should be 100 joules per cm2 or more in tumors up to 2 cm in size. There was no CR in tumors more than 2 cm in size. No early side effects were seen from administration of HpD. Sensitivity to sunlight was seen in 4 cases.

Whole Bladder Wall Photoradiation Therapy for Carcinoma in Situ of the Bladder: A Preliminary Report

Whole bladder wall photoradiation therapy, using a hematoporphyrin derivative as a sensitizer, the red light (wavelength 630 plus or minus 1.6 nm.) of an argon dye laser as the source of excitation energy and a motor driven laser light scattering optic, was performed in 2 patients with multicentric carcinoma in situ of the bladder. The total light dose was 10 J. per cm.2. Acute vesical inflammatory changes developed in the bladder wall lining, associated with a reduction of bladder capacity, which, however, disappeared within 3 months after photoradiation therapy. The anticancer effect of photoradiation therapy was followed by urinary cytologic and cystoscopic examinations for 4 months. Occasional discharges of clusters of vacuolated cancer cells or sheets of vesical detached cells in the urine were observed for 2 weeks after photoradiation therapy but, thereafter, repeat urinary cytologic and cystoscopic examinations revealed no malignancy.

Pathological effects of neoadjuvant hormonal therapy help predict progression of prostate cancer after radical prostatectomy.

Background: It is not clear whether pathological changes following neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy have any value as predictors of progression in prostate cancer.

Renal angiomyolipoma associated with inferior vena caval and right atrial thrombus.

A 40-year-old woman with no stigmata of tuberous sclerosis presented with sudden onset of pain in the right flank. Routine laboratory data were normal except for mild anemia. Computerized tomography revealed a ruptured lesion with low attenuation values in the fat range as well as tumor thrombus extending into the right renal vein and inferior vena cava. Magnetic resonance imaging confirmed a right renal mass extending into the right atrium through the right renal vein and inferior vena cava (fig. 1). A 1 cm. tumor was also noted in the left kidney. All findings were diagnostic of bilateral renal angiomyolipoma associated with right renal vein and inferior vena caval invasion as well as right atrial thrombosis and right renal rupture. Conservative treatment resulted in improved laboratory findings and symptoms. However, the potentially lethal nature of an atrial thrombus prompted radical surgery. Right nephrectomy and

Urokinase inhibitor in patients with bladder cancer

SummaryPlasma and tissue inhibitory activities were measured by the fibrin plate method in 33 plasma samples and 25 cancerous tissue specimens from 48 patients with bladder cancer, and were compared with those of normal plasma and bladder tissues, respectively. Both the inhibitory activities were significantly higher in the patients than in normal subjects. In addition, they were significantly higher in patients with cancer of high grades (Grades 2, 3 and 4) and high stages (Stages B, C and D) than in those with cancer of low grade (Grade 1) and low stage (Stage A), respectively. A significant decrease of plasma urokinase inhibitory activity was observed in blood samples obtained 3 weeks after surgical excision of the tumor as compared with that measured before the operation. The physiologic and clinical significances of these findings are discussed.

The prophylactic use of thio-tepa and urokinase in transitional cell carcinoma of the bladder: a preliminary report.

The prevention of recurrences of bladder cancer was attemped in 48 patients by means of the combined intravesical instillation of thio-tepa and urokinase and in 28 patients through the instillation of thio-tepa alone. The recurrence rates of both therapies for the postoperative 18 months were 7.9 and 32.6 per cent, respectively, indicating a significant drop in the recurrence rate in the group subjected to the combined therapy. No significant difference was found between the 2 instillation groups in terms of the blood transmission of 32-P thio-tepa. Serious leukopenia was found in 2 of the 48 patients receiving the combined instillation therapy but we concluded that this was not attributable to the use of urokinase.

Anticancer drug sensitivity in vitro in the bladder cancer cell line, KK-47 and prophylactic use of carbazilquinone and urokinase in bladder cancer.

SummaryUsing colony formation technique and KK-47 cell line established from a human bladder transitional cell carcinoma, the effects of 6 anticancer drugs, thio-TEPA, Bleomycin, mitomycin C, carbazilquinone, Adriamycin and cis-Platinum, were compared. On the results of tests performed to establish the drug concentration required to achive a 50% inhibition of cell survival, carbazilquinone was chosen for the prevention of recurrences of bladder cancer. The two groups studied consisted of 56 patients (previously untreated group) who were rendered free of tumours by surgical intervention and of 19 patients (thio-TEPA failures group) who had experienced a persistent recurrence of tumours after prophylactic thio-TEPA instillations and were presumed free of the recurrence of tumours after the next surgical intervention. The 2 groups were subjected to prophylactic combined intravesical instillation therapy with carbazilquinone and urokinase. In the previously untreated group, 6 of the 56 patients (10. 7%) had a recurrence of tumours, and the recurrence rate after 21 months was 16. 7%, using the actuarial method. In the thio-TEPA failures group, 12 of the 19 patients (63. 2%) had a recurrence of tumours, a rate at 21 months of 76. 1%. A considerable drop in the recurrence rate was obtained by the combined instillation therapy in the previously untreated group. The results in the thio-TEPA failures group suggested the presence of a cross-resistance between both alkylating agents, and of a persistent susceptibility to multifocal lesions. No bone marrow depression was observed but an episode of anaphylactic shock attributable to the use of carbazilquinone occurred in 1 out of a total 75 patients.

V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY

patient’s giant duplicated kidney. This 2.96 mm instrument shaft was inserted through a small puncture and maintains the nearly scarless cosmesis of LESS surgery. The 5 mm grasping tip, which can be changed through any conventional laparoscopic port, was robust and allowed for the effective manipulation of this giant kidney. The estimated blood loss was 100 cc and the operative time was 310 min. The patient tolerated the procedure well without any perioperative complications. The patient was discharged home on POD 1 and required no narcotic pain medications. CONCLUSIONS: The addition of the PEAL instrument facilitated the completion of LESS nephrectomy in a patient with complicated anatomy. By using these externally assembled instruments, PEAL provides a functional, robust 5 mm tip and reestablishes instrument triangulation, thereby greatly simplifying LESS surgery. In addition the <3mm shaft maintains a nearly scarless cosmetic outcome. The PEAL instruments can be used to simplify LESS, reduce the invasiveness of conventional laparoscopic surgery or as stand-alone surgical paradigm. For these reasons we feel that the PEAL paradigm is a promising new surgical approach